Head and Neck Medicine by Alexandros G.Sfakianakis: 02/02/17

Πέμπτη 2 Φεβρουαρίου 2017

Variability of skin pH after the use of different collagen gels

Summary

Background

Skin pH is an important parameter indicating the condition of the skin because imbalance can contribute to the development of skin problems and earlier aging. Individual skin pH depends on many factors such as hydration, sweating, sebum excretion, genetics, sex, and age. Additionally, it can be affected by exogenous factors such as cosmetics.

Aims

The aim of the study was to compare different collagen gels and determine whether and to what extent they change the pH of the skin.

Patients/Methods

Baseline skin pH was measured in 49 women aged between 19 and 23. It was measured again 20 and 60 minutes following of the application of four collagen gels.

Results

The mean physiological pH values of the forehead and cheek were 5.67 and 5.76, respectively. The analysis of variance and post hoc test revealed that gel no. 1, gel no. 2, and gel no. 3 (but not 4) significantly changed the skin pH.

Conclusion

Collagen gel should be neutral for the skin barrier; however, most collagen skin care preparations significantly changed skin pH. Methods of processing and stabilizing the collagen may account for the difference in effect between gels, but further research is required.

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Matrix meets Inflammation and DNA Repair: Meeting Report of the 3rd ADF Round Table

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Excessive angiogenesis associated with psoriasis as a cause for cardiovascular ischaemia

Abstract

Psoriasis, a common disease affecting 2-3% of the UK population, produces significant impairment of quality of life and is an immense burden on sufferers and their families. Psoriasis is associated with significant cardiovascular co-morbidity and the metabolic syndrome. Angiogenesis, a relatively under-researched component of psoriasis, is a key factor in pathogenesis of psoriasis and also contributes to the development of atherosclerosis. Vascular endothelial growth factor (VEGF) is a well established mediator of pathological angiogenesis which is upregulated in psoriasis. It is possible that, in patients with psoriasis, cutaneous angiogenesis may be both a marker for systemic vascular pathology and a novel therapeutic target. In this viewpoint paper the role of VEGF mediated angiogenesis as a cause for cardiovascular events in patients with psoriasis is explored.

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Loss of cutaneous microbial diversity during first three weeks of life in very low birth weight infants

Abstract

Neonatal sepsis (NS) is a frequent problem in neonatal intensive care, especially in preterm and very low birth weight (VLBW) infants. The objective of the study was to characterize the cutaneous bacterial microbiome in VLBW infants treated in the neonatal intensive care unit (NICU). Non-invasive skin microbiome specimens were taken repeatedly from 12 VLBW infants during treatment in NICU starting on the first day of life. All infants received benzylpenicillin and netilmicin during the first 1-5 postnatal days. Samples were also collected from incubators. High cutaneous microbial diversity was present at birth in 11/12 of the infants, but the diversity decreased substantially after the first weeks of life in all infants regardless of their infection status. After the loss of diversity, one Staphylococcus operational taxonomic unit (OTU) dominated the skin microbiome. Recovery of microbial diversity was seen in 6 of 12 neonates. The microbiome of incubators showed typical environmental bacterial genera. Maternal antibiotic treatment, the etiology of the preterm birth or being born by C-section did not appear to affect the diversity of skin microbiota at birth, and no correlation was found between cutaneous microbiome and NS.

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Overcoming cell death resistance in skin cancer therapy: Novel translational perspectives

Abstract

In the last decade, significant progress has been made in understanding skin cancer cell death resistance mechanisms, and a number of new treatment strategies have been developed. Systematic approach genomic studies of various cancer types have opened new possibilities for the development of anti-cancer therapies. However, there are still fundamental gaps in the challenging biomedical puzzle, which will form a complete picture for curing cancer. Thus, herein, we describe some of the current cancer treatment strategies and discuss additional cell signalling pathways that could be potential targets for skin cancer treatment.

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Dickkopf-1 is involved in dexamethasone-mediated hair follicle regression

Abstract

The stress-related neurohormones including glucocorticoids (GCs) are secreted by hair follicles (HFs) and GCs suppress murine hair growth in vivo. In this study, we found that dexamethasone (Dex), a synthetic GC, increased the expression of dickkopf-1 (DKK1), a known catagen inducer, in dermal papilla (DP) cells but not in follicular keratinocytes. The neutralizing DKK1 antibody significantly attenuated the Dex-induced inhibition of human hair shaft elongation. In addition, the neutralizing Dkk1 antibody delayed Dex-induced catagen in mice. Collectively, our data strongly suggest that stress-related neurohormones cause DP cells to secrete DKK1, thereby leading to stress-associated disturbances in hair growth.

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Association of SNPs from IL1A, IL1B, and IL6 Genes with Human Cytomegalovirus Infection Among Pregnant Women

Viral Immunology , Vol. 0, No. 0.

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Role of TLR9 in Oncogenic Virus-Produced Cancer

Viral Immunology , Vol. 0, No. 0.

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Relative mRNA Expression Levels of Restriction Factors and Antiviral Genes in Fetal and Adult Human Monocytes and Monocyte-Derived Macrophages

Viral Immunology , Vol. 0, No. 0.

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The Synergistic Effect of TNFα -308 G/A and TGFβ1 -509 C/T Polymorphisms on Hepatic Fibrosis Progression in Hepatitis C Virus Genotype 4 Patients

Viral Immunology , Vol. 0, No. 0.

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What nasal endoscope adds in septoplasty

Publication date: Available online 2 February 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Zeyad Mohamed Mandour
A study was conducted to assess the advantages of endoscopic septoplasty over the conventional septoplasty.Sixty patients having symptomatic deviated nasal septal were randomly divided into two groups of 30 patients each. One group underwent conventional septoplasty and the other group underwent endoscopic septoplasty. The groups were compared regarding the relief of symptoms after surgery and complications.The symptoms postoperatively and the objective assessment were significantly less in endoscopic septoplasty group.Endoscopic septoplasty is a fast developing concept and gaining popularity as it provides a direct targeted approach to the septal anatomic deformity, allowing a minimally invasive procedure with limit septal mucosal flap dissection and removal of small cartilaginous and/or bony deformity.

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Reliability of inertial sensors in the assessment of patients with vestibular disorders: a feasibility study

Abstract

Background

Vestibular disorders affect an individual's stability, balance, and gait and predispose them to falls. Traditional laboratory-based semi-objective vestibular assessments are intrusive and cumbersome provide little information about their functional ability. Commercially available wearable inertial sensors allow us to make this real life assessments objective, with a detailed view of their functional abilities. Timed Up and Go (TUG) and Postural Sway tests are commonly used tests for gait and balance assessments. Our aim was to assess the feasibility, test-retest reliability and ability to classify fall status in individuals with vestibular disorders using parameters derived from the commercially available wearable system (inertial sensors and the Mobility Lab Software, APDM, Inc.).

Methods

We recruited 27 individuals diagnosed either with unilateral or bilateral vestibular loss on vestibular function testing. Instrumented Timed Up and Go (iTUG) and Postural Sway (iSway) were administered three times during the first session and then repeated at a similar time the following week. To evaluate within and between sessions reliability of the parameters the Intra-Class Correlation coefficient (ICC) was used. Subsequently, the ability of reliable parameters (ICC ≥ 0.8) to classify fallers from non-fallers was estimated.

Results

The iTUG test parameters showed good within and between sessions' reliability with mean ICC (between-sessions) values of 0.81 ± 0.17 and 0.69 ± 0.15, respectively. For the iSway test, the relative figures were; 0.76 ± 0.13 and 0.71 ± 0.14, respectively. A retrospective falls classification analysis with past 12 months falls history data yielded an accuracy of 66.70% with an area under the curve of 0.79. Mean Distance from centre of COP (mm) of accelerometer's trajectory (m/s²) from the iSway test was the only significant parameter to classify fallers from non-fallers.

Conclusions

Using a commercially available wearable system a subset of reliable iTUG and iSway parameters were identified and their ability to classify fallers were estimated. These parameters have potential to augment assessments of vestibular patients to enable clinicians and therapists to provide objective, tailored, personalised interventions for their gait and postural control and also to objectively evaluate and monitor the efficiency of their interventions.

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Penetrating Trauma: A Practical Guide on Operative Technique and Peri-Operative Management, 2nd ed.

No abstract available

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Cases in Emergency Airway Management.

No abstract available

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Clinical Fluid Therapy in the Perioperative Setting.

No abstract available

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Mobile Technology in the Perioperative Arena: Rapid Evolution and Future Disruption.

Throughout the history of medicine, physicians have relied upon disruptive innovations and technologies to improve the quality of care delivered, patient outcomes, and patient satisfaction. The implementation of mobile technology in health care is quickly becoming the next disruptive technology. We first review the history of mobile technology over the past 3 decades, discuss the impact of hardware and software, explore the rapid expansion of applications (apps), and evaluate the adoption of mobile technology in health care. Next, we discuss how technology serves as the vehicle that can transform traditional didactic learning into one that adapts to the learning behavior of the student by using concepts such as the flipped classroom, just-in-time learning, social media, and Web 2.0/3.0. The focus in this modern education paradigm is shifting from teacher-centric to learner-centric, including providers and patients, and is being delivered as context-sensitive, or semantic, learning. Finally, we present the methods by which connected health systems via mobile devices increase information collection and analysis from patients in both clinical care and research environments. This enhanced patient and provider connection has demonstrated benefits including reducing unnecessary hospital readmissions, improved perioperative health maintenance coordination, and improved care in remote and underserved areas. A significant portion of the future of health care, and specifically perioperative medicine, revolves around mobile technology, nimble learners, patient-specific information and decision-making, and continuous connectivity between patients and health care systems. As such, an understanding of developing or evaluating mobile technology likely will be important for anesthesiologists, particularly with an ever-expanding scope of practice in perioperative medicine. (C) 2017 International Anesthesia Research Society

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Enhanced Recovery for Major Abdominopelvic Surgery, 1st Edition.

No abstract available

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The Effect of Fixation Technique on Continuous Interscalene Nerve Block Catheter Success: A Randomized, Double-Blind Trial.

BACKGROUND: Continuous peripheral nerve blocks offer advantages over single-injection blocks, including extended analgesia and reduction in opioid consumption. These benefits require that the perineural catheter remain intact for the duration of the planned local anesthetic infusion. Mechanical displacement of catheters, leaking, and consequent failure are known complications. The aim of this study was to evaluate continuous perineural catheter tip-to-nerve apposition in vivo over 48 hours comparing 2 different simple fixation strategies. METHODS: Subjects presenting for a continuous interscalene nerve block were randomized to perineural catheter fixation with 1 of 2 types of adhesive: Dermabond (2-octylcyanoacrylate) or Mastisol (alcohol 23A, gum mastic, storax, and methyl salicylate), covered with a simple transparent dressing. The primary outcome was the evaluation of catheter-to-nerve apposition maintenance over 48 hours via both a blinded ultrasound evaluation of local anesthetic distribution and a blinded clinical assessment. Secondary outcomes included leakage at the catheter site, pain scores, opioid consumption, catheter-to-skin migration at the insertion site, and patient satisfaction. RESULTS: Sixty-six subjects were recruited and randomized to compare adhesive group catheter tip-to-nerve apposition on postoperative day 2 (POD 2). Within the intention-to-treat cohort, a statistically significant decrease of perineural catheter tip-to-nerve apposition in the Mastisol group (64.7%) compared with the Dermabond group (90.6%) on POD 2 (odds ratios [OR] 0.19; 95% confidence interval [CI] 0.05-0.75; P = .012) was observed. Similar results were observed on POD 1 (OR 0.19; 95% CI 0.03-1.38; P = NS) and POD 2 (OR 0.14; 95% CI 0.02-0.97; P = .008) within the as-treated cohort. Catheter leakage (OR 67; 95% CI 7.3-589) and median catheter migration difference at the skin insertion site (2.0 cm; 95% CI 0.5-2.5) were also significantly greater in the Mastisol group than in the Dermabond group from POD 0 to POD 2 (P <.001 median postoperative opioid consumption difference in morphine equivalents ci to was not significantly different between the dermabond and mastisol groups through pod .542 conclusions: perineural catheter fixation with continuous interscalene nerve block improves maintenance of catheter-to-nerve apposition when compared mastisol. international anesthesia research society>

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Epidemiology of Cardiac Arrest During Hospitalization for Delivery in Canada: A Nationwide Study.

BACKGROUND: Cardiac arrest in pregnancy is a rare and devastating condition with high mortality and morbidity. The objective of this study was to generate information about maternal cardiac arrest in Canada by examining the frequency, temporal incidence, associated conditions, potential etiologies, and survival rates. METHODS: This retrospective population-based study used hospitalization data from the discharge abstract database of the Canadian Institute for Health Information relating to obstetric deliveries in Canada from April 1, 2002, to March 31, 2015. The data were accessed through the Public Health Agency of Canada's (PHAC) Canadian Perinatal Surveillance System. Cases of cardiac arrest were identified using the diagnostic and intervention codes from the International Statistical Classification of Diseases and the Canadian Classification of Health Interventions, respectively. Data on patient demographics, medical and obstetrical conditions, and potential etiologies of cardiac arrest were collected. Multivariable logistic regression analysis was used to identify conditions associated with cardiac arrest. RESULTS: There were 286 cases of maternal cardiac arrest among 3,568,597 hospitalizations for delivery during the 13-year period. A total of 204 (71.3%) women survived to hospital discharge (95% confidence interval, 65.7%-76.5%). There was no significant variation in the incidence of cardiac arrest or survival from arrest over time or across provinces. Among the pre-existing conditions, hypertensive disorders of pregnancy, gestational diabetes, malignancy, and diseases of the respiratory and nervous system were found to be significantly associated with cardiac arrest. Among the obstetrical conditions, placental abnormalities and polyhydramnios were associated with cardiac arrest. The common potential etiologies included postpartum hemorrhage, heart failure, amniotic fluid embolism, and complications of anesthesia. CONCLUSIONS: In this first Canadian study, the incidence of cardiac arrest during pregnancy was found to be 1:12,500 deliveries. The survival rate reported in our study is higher than reported previously in other countries. Our study findings contribute to better inform the development and implementation of policies and programs in an effort to prevent and manage this condition. (C) 2017 International Anesthesia Research Society

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Associations Between Impaired Cerebral Blood Flow Autoregulation, Cerebral Oxygenation, and Biomarkers of Brain Injury and Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery.

BACKGROUND: Increasing evidence links postoperative cognitive dysfunction (POCD) to surgery and anesthesia. POCD is recognized as an important neuropsychological adverse outcome in surgical patients, particularly the elderly. This prospective cohort study aimed to investigate whether POCD is associated with impaired intraoperative cerebral autoregulation and oxygenation, and increased levels of biomarkers of brain injury. METHODS: Study subjects were patients >=65 years of age scheduled for major noncardiac surgery. Cognitive function was assessed before and 1 week after surgery. POCD was diagnosed if a decline of >1 standard deviation of z-scores was present in >=2 variables of the test battery. The incidence of POCD 1 week after surgery was modeled as a multivariable function of the index of autoregulation (MxA) and tissue oxygenation index (TOI), adjusting for baseline neuropsychological assessment battery (Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery [CERAD-NAB]) total score and the maximum C-reactive protein (CRP) concentration. The biomarkers of brain injury neuron-specific enolase and S100[beta] protein, age, and level of education were included in secondary multivariable logistic regression analyses. RESULTS: Of the 82 patients who completed the study, 38 (46%) presented with POCD 1 week after surgery. In the multivariable regression analysis, higher intraoperative MxA (odds ratio [OR; 95% confidence interval (CI)], 1.39 [1.01-1.90] for an increase of 0.1 units, P = .08 after Bonferroni adjustment), signifying less effective autoregulation, was not associated with higher odds of POCD. The univariable logistic regression model for MxA yielded an association with POCD (OR [95% CI], 1.44 [1.06-1.95], P = .020). Tissue oxygenation index (1.12 [0.41-3.01] for an increase of 10%, P = 1.0 after Bonferroni adjustment) and baseline CERAD-NAB total score (0.80 [0.45-1.42] for an increase of 10 points, P = .45) did not affect the odds of POCD. POCD was associated with elevated CRP on postoperative day 2 (median [interquartile range]; 175 [81-294] vs 112 [62-142] mg/L, P = .033); however, the maximum CRP value (OR [95% CI], 1.35 [0.97-1.87] for a 2-fold increase, P = .07) had no distinct effect on POCD. CONCLUSIONS: Impairment of intraoperative cerebral blood flow autoregulation is not predictive of early POCD in elderly patients, although secondary analyses indicate that an association probably exists. (C) 2017 International Anesthesia Research Society

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Publication Rate of Abstracts Presented at the Society for Obstetric Anesthesia and Perinatology Annual Meetings 2010-2014.

The Society for Obstetric Anesthesia and Perinatology (SOAP) annual meeting provides a forum to present new scientific work with the goal of broader dissemination of knowledge. The objective of this study was to evaluate the proportion of research abstracts presented at SOAP meetings, from 2010 to 2014, which resulted in peer-reviewed publications. The abstract-to-publication rate was compared with the percent of abstracts presented at biomedical meetings resulting in publication, as estimated by a 2007 Cochrane Review. The SOAP abstract-to-publication rate was lower than that of the Cochrane Review (26.8% vs 44.5%, P

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Clinical Significance of Portal Hypertension Diagnosed With Bedside Ultrasound After Cardiac Surgery.

BACKGROUND: Portal venous flow pulsatility detected by Doppler ultrasound is a sign of congestive heart failure in noncritically ill patients. The assessment of portal and splenic venous flows has never been reported in patients undergoing cardiac surgery. METHODS: This is a case series performed in patients undergoing cardiac surgery between February 2014 and February 2015 in which portal and/or splenic venous flows were assessed by the attending anesthesiologist during surgery or by the intensivist after surgery using transthoracic echography in 9 patients or transesophageal echocardiography in 5 patients. Data collection was done retrospectively by reviewing intraoperative and postoperative monitoring documents. The technique of assessment is detailed in this article. RESULTS: We report the abnormal portal and/or splenic venous flow pulsatility from 14 patients perioperatively. At the time of pulsatility detection, patients had a median cumulative fluid balance of 3.8 L (interquartile range: 0-4.6 L) and a median right atrial pressure of 14.0 mm Hg (interquartile range: 12.0-15.5 mm Hg). In some patients (4/14), signs of right ventricular dysfunction on echocardiography and/or right ventricular pressure monitoring were present. CONCLUSIONS: Doppler evaluation of portal and splenic venous flow using transthoracic echography and transesophageal echocardiography may represent a promising modality to assess end-organ venous congestion in cardiac surgery patients. (C) 2017 International Anesthesia Research Society

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Why Anesthesiologists Could and Should Become the Next Leaders in Innovative Medical Entrepreneurism.

No abstract available

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Relationship of Medial versus Superior Vocal-Cord Location of T1 Squamous Cell Carcinoma with Tumor Recurrence

To determine if the clinical behavior of T1 glottic squamous cell carcinoma varies by its location on the medial free edge or upper aspect of the vocal cords.

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Role of Adenoidectomy in Chronic Nasal Obstruction After Nasal Steroid Therapy Failure

To identify clinical characteristics of pediatric patients that failed nasal steroid therapy for management of chronic nasal obstruction and to evaluate the efficacy of adenoidectomy in this subset of patients.

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Acellular dermal graft pharyngeal repair augmentation after laryngectomy

Pharyngocutaneous fistula (PCF) after laryngectomy continues to be a serious complication, especially after radiation. Recruitment of non-radiated tissue into the surgical defect may decrease the risk of fistula. These techniques however have significant morbidity and increases operative time. We hypothesized that using acellular dermal graft to reinforce the pharyngeal closure could decrease the risk of fistula, without the added morbidity of a vascularized flap.

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Murine models of germinal center derived-lymphomas

Parham Ramezani-Rad | Robert C Rickert

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Corrigendum to “Combined medial canthopexy and lateral tarsal strip for floppy eyelid syndrome” [Am J Otolaryngol 37 (2016) 240–244]

In the article "Combined medial canthopexy and lateral tarsal strip for floppy eyelid syndrome," funding information was inadvertently omitted. The article was funded in part by grants provided through Research to Prevent Blindness, New York, NY.

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The role of immunosuppression in squamous cell carcinomas arising in seborrheic keratosis

Seborrheic keratoses (SK) are common skin neoplasms considered to be benign. Reports of associated squamous cell carcinoma arising within seborrheic keratosis (SCC-SK) have been described.

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The cost of topical immunomodulator therapy in Medicare patients varies by prescriber specialty

Topical immunomodulators (TI)—including corticosteroids, calcineurin inhibitors, and vitamin D analogues—are commonly prescribed in multiple specialties, but cost comparisons are lacking.

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Malignancy rates in a large cohort of patients with systemically treated psoriasis in a managed care population

Moderate to severe psoriasis often requires treatment with systemic agents, many of which have immunosuppressive properties and could increase cancer risk, including nonmelanoma skin cancer (NMSC).

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Reliability of inertial sensors in the assessment of patients with vestibular disorders: a feasibility study

Duplication Anomalies of the Internal Auditory Canal: Varied Spectrum

Abstract

Duplication anomalies of the internal auditory canal are rare, with only twenty-one cases reported in literature. These range from incomplete partition and complete partition to true duplication. We present three cases showing this entire spectrum of duplication abnormalities and discuss the role of imaging in the preoperative work up of such patients planned for cochlear implant.

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Quality of Life Rating for Dizziness: A Self-reporting Questionnaire

Abstract

The aim of the present study was to develop a questionnaire in Kannada language which assesses the handicapping consequences of dizziness. A cross sectional study design and a convenient type of sampling was used to recruit the participants. A total of 36 participants in age range of (18–60 years of age) who reported to have dizziness or vertigo for at least three months of period and who knew to read and write in kannada language participated. The overall questionnaire was found to have an internal consistency α = 0.935 on cronbach's alpha test and for test retest reliability (r = 0.988) on intra-class correlation coefficient measure. The present studies provide International Classification of Functioning, Disability and Health based questionnaire in kannada which can be used in the clinical set up to assess the quality of life (QOL) in individuals with Vertigo or Dizziness. It will also help to understand the impact of dizziness on QOL from individual's perspective.

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Cortical maturation in children with cochlear implants: Correlation between electrophysiological and behavioral measurement

by Liliane Aparecida Fagundes Silva, Maria Inês Vieira Couto, Fernanda C. L. Magliaro, Robinson Koji Tsuji, Ricardo Ferreira Bento, Ana Claudia Martinho de Carvalho, Carla Gentile Matas

Central auditory pathway maturation in children depends on auditory sensory stimulation. The objective of the present study was to monitor the cortical maturation of children with cochlear implants using electrophysiological and auditory skills measurements. The study was longitudinal and consisted of 30 subjects, 15 (8 girls and 7 boys) of whom had a cochlear implant, with a mean age at activation time of 36.4 months (minimum, 17 months; maximum, 66 months), and 15 of whom were normal-hearing children who were matched based on gender and chronological age. The auditory and speech skills of the children with cochlear implants were evaluated using GASP, IT-MAIS and MUSS measures. Both groups underwent electrophysiological evaluation using long-latency auditory evoked potentials. Each child was evaluated at three and nine months after cochlear implant activation, with the same time interval adopted for the hearing children. The results showed improvements in auditory and speech skills as measured by IT-MAIS and MUSS. Similarly, the long-latency auditory evoked potential evaluation revealed a decrease in P1 component latency; however, the latency remained significantly longer than that of the hearing children, even after nine months of cochlear implant use. It was observed that a shorter P1 latency corresponded to more evident development of auditory skills. Regarding auditory behavior, it was observed that children who could master the auditory skill of discrimination showed better results in other evaluations, both behavioral and electrophysiological, than those who had mastered only the speech-detection skill. Therefore, cochlear implant auditory stimulation facilitated auditory pathway maturation, which decreased the latency of the P1 component and advanced the development of auditory and speech skills. The analysis of the long-latency auditory evoked potentials revealed that the P1 component was an important biomarker of auditory development during the rehabilitation process.

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Early bone formation around immediately loaded implants with nanostructured calcium-incorporated and machined surface: a randomized, controlled histologic and histomorphometric study in the human posterior maxilla

Abstract

Objective

The aim of this randomized, controlled histologic/histomorphometric study was to compare the early bone formation around immediately loaded implants with nanostructured calcium-incorporated (NCI) and machined (MA) surface, placed in the human posterior maxilla.

Materials and methods

Fifteen fully edentulous patients (six males; nine females; mean age 57.9 ± 6.7 years) were selected for this study. Each patient was installed with two temporary transmucosal implants, with different surfaces: one NCI (test) and one MA (control) implant. All temporary implants were placed in the posterior maxilla, according to a split-mouth design, to help to support an interim complete maxillary denture. After 8 weeks, all temporary transmucosal implants were retrieved for histologic/histomorphometric evaluation. The bone-to-implant contact (BIC%) and the bone density (BD%) were calculated. The Wilcoxon matched-pairs signed-rank test was used to evaluate differences (BIC%, BD%) between the surfaces. The level of significance was set at 0.05.

Results

Eight weeks after placement, 24 clinically stable implants (12 test, 12 control) were subjected to histologic/histomorphometric evaluation. In the MA implants, the histomorphometric evaluation revealed a mean BIC(±SD)% and BD(±SD)% of 21.2(±4.9)% and 29.8(±7.8)%, respectively. In the NCI implants, the histomorphometric analysis revealed a mean BIC(±SD)% and BD(±SD)% of 39.7(±8.7)% and 34.6(±7.2)%, respectively. A statistically significant difference was found between the two surfaces with regard to BIC% (p < 0.001), while no significant difference was found with regard to BD% (p = 0.09).

Conclusions

The NCI surface seems to increase the peri-implant endosseous healing properties in the native bone of the posterior maxilla, under immediate loading conditions, when compared with the MA surface.

Clinical relevance

Under immediate loading conditions in the human posterior maxilla, the nanostructured calcium-incorporated surface has led to better histologic and histomorphometric results than the machined surface; therefore, the clinical use of implants with nanostructured calcium-incorporated surface may be beneficial in the posterior maxilla, under immediate loading protocol.

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Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry?

Abstract

Objectives

Platelet rich plasma (PRP) has been utilized in regenerative dentistry as a supra-physiological concentrate of autologous growth factors capable of stimulating tissue regeneration. Despite this, concerns have been expressed regarding the use of anti-coagulants, agents known to inhibit wound healing. In this study, a liquid formulation of platelet rich fibrin (PRF) termed injectable-PRF (i-PRF) without the use of anti-coagulants was investigated.

Materials and methods

Standard PRP and i-PRF (centrifuged at 700 rpm (60G) for 3 min) were compared for growth factor release up to 10 days (8 donor samples). Furthermore, fibroblast biocompatibility at 24 h (live/dead assay); migration at 24 h; proliferation at 1, 3, and 5 days, and expression of PDGF, TGF-β, and collagen1 at 3 and 7 days were investigated.

Results

Growth factor release demonstrated that in general PRP had higher early release of growth factors whereas i-PRF showed significantly higher levels of total long-term release of PDGF-AA, PDGF-AB, EGF, and IGF-1 after 10 days. PRP showed higher levels of TGF-β1 and VEGF at 10 days. While both formulations exhibited high biocompatibility and higher fibroblast migration and proliferation when compared to control tissue-culture plastic, i-PRF induced significantly highest migration whereas PRP demonstrated significantly highest cellular proliferation. Furthermore, i-PRF showed significantly highest mRNA levels of TGF-β at 7 days, PDGF at 3 days, and collagen1 expression at both 3 and 7 days when compared to PRP.

Conclusions

i-PRF demonstrated the ability to release higher concentrations of various growth factors and induced higher fibroblast migration and expression of PDGF, TGF-β, and collagen1. Future animal research is now necessary to further validate the use of i-PRF as a bioactive agent capable of stimulating tissue regeneration.

Clinical relevance

The findings from the present study demonstrate that a potent formulation of liquid platelet concentrates could be obtained without use of anti-coagulants.

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Photobiomodulation laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats

Abstract

The purpose of this study is to investigate the effect of pulsed electrical field (PEF) and photobiomodulation laser (PBM) on the viability of the TRAM flap in diabetic rats. Fifty Wistar rats were divided into five homogeneous groups: Group 1—control; Group 2—diabetics; Group 3—diabetics + PEF; Group 4—diabetic + laser 660 nm, 10 J/cm², 0.27 J; Group 5—diabetic + laser 660 nm, 140 J/cm², 3.9 J. The percentage of necrotic area was evaluated using software Image J®. The peripheral circulation of the flap was evaluated by infrared thermography FLIR T450sc (FLIR® Systems—Oregon USA). The thickness of the epidermis (haematoxylin-eosin), mast cell (toluidine blue), leukocytes, vascular endothelial growth factor, fibroblast and newly formed blood vessels were evaluated. For the statistical analysis, the Kruskal-Wallis test was applied followed by Dunn and ANOVA test followed by Tukey with critical level of 5% (p < 0.05). The PEF reduced the area of necrosis, decreased the leukocytes, increased the mast cells, increased the thickness of epidermis and increased newly formed blood vessels when it was compared to the untreated diabetic group of animals. Laser 660 nm, fluence 140 J/cm² (3.9 J) showed better results than the 10 J/cm² (0.27 J) related to reduction of the area of necrosis and the number of leukocytes, increased mast cells, increased thickness of the epidermis, increased vascular endothelial growth factor, increased fibroblast growth factor and increase of newly formed blood vessels in diabetic animals. The laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.

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Quality of Life Rating for Dizziness: A Self-reporting Questionnaire

Abstract

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Association between computed tomography findings and clinical symptoms in chronic rhinosinusitis with and without nasal polyps

Abstract

Objective of this study was to test whether there is a difference between chronic rhinosinusitis patients with (CRSwNP) and without (CRSsNP) nasal polyps in the association of extent of disease on CT scans with symptom severity and health-related quality-of-life (HRQL) impairment. Data sets from 271 chronic rhinosinusitis (CRS) patients who completed the Sino-Nasal Outcome Test 22 (SNOT-22) and visual analog scale (VAS) scores were subjected to principal component analysis (PCA) to identify a symptom components related to CRS. After controlling for demographics, medical therapy, and comorbidities, the association between symptom components/items excluded from PCA and Lund–Mackay score (LMS) was evaluated. No association was found between the total SNOT-22 score and LMS in CRS patients. There was an independent association between a higher "nasal" symptom component derived from SNOT-22 PCA and LMS in patients with CRSwNP (p < 0.001), but not in CRSsNP patients, with a statistically significant difference between two patient subsets (p = 0.003). In patients with CRSsNP, higher (worse) SNOT-22 "facial pain" was associated with lower LMS (p = 0.022), although the estimated change in LMS was modest. Considering VAS PCA components, higher "nasal" symptoms were associated with higher LMS in CRSwNP patients (p < 0.001) but not in CRSsNP, with a statistically significant difference between CRS groups (p = 0.024). A higher "pain" PCA component was associated with lower LMS in CRSsNP patients (p = 0.019). This study found significant differences in the relationship between symptom burden and CT scores between CRS phenotypes and no association between HRQL impairment and CT scores.

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Decision to Treat Actinic Keratosis Depends on How Physicians Frame Risks

Reuters Health Information

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Improving the Evidence for Inferior Turbinate Surgery in Children

Allergic rhinitis (AR) is one of the most common chronic diseases in children, and its prevalence among children in the United States has been increasing in recent years. Allergic rhinitis and its associated comorbidities have accounted for 800 000 to 2 million lost school days annually and has been shown to have an impact on learning, behavior, and attention. Thus, the impact of AR and chronic nasal congestion on the quality of life (QOL) for both affected children and their parents is substantial.

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Quality of Life in Children After Submucous Inferior Turbinoplasty

This case series examines changes in sinonasal quality of life for children after outfracture of inferior turbinates and concomitant submucous microdebrider inferior turbinoplasty for chronic nasal congestion.

http://ift.tt/2kWrdGJ

Individualized Treatment of Laryngeal Cancer

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Wolf et al describe very high survival rates in an unselected cohort of 247 patients with advanced laryngeal cancer. These patients were treated with a program of individualized bioselection. All of us invested in the care of patients with advanced laryngeal cancer must breathe a deep sigh of relief. Only 10 years ago, Hoffman et al, in a landmark review of the national cancer database, evaluated the outcome of 158 426 patients with laryngeal cancer. Between the years of 1985 and 2001, the survival rate had gone down. So what has changed?

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Left-Sided Facial Pain, Fullness, and Trismus

A young man had left-sided facial pain, fullness, trismus, and decreased acuity in his left lower visual field; physical examination revealed a mass that extended inferiorly to the zygoma into the buccal cavity and posterolaterally to the left superior molars. What is your diagnosis?

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Individualized Bioselection Treatment Methods in Laryngeal Cancer

This cohort study evaluates the association between individualized bioselection treatment decision criteria and survival of patients with laryngeal cancer.

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Relationship of Medial versus Superior Vocal-Cord Location of T1 Squamous Cell Carcinoma with Tumor Recurrence

Publication date: Available online 2 February 2017
Source:American Journal of Otolaryngology
Author(s): Uri Alkan, Yuval Nachalon, Aron Popovtzer, Sharon Tzelnick, Dan Yaniv, Jacob Shvero
ObjectiveTo determine if the clinical behavior of T1 glottic squamous cell carcinoma varies by its location on the medial free edge or upper aspect of the vocal cords.Study DesignRetrospective cohort.SettingSingle tertiary university-affiliated medical center.Subjects and MethodsClinical, treatment, and outcome data were collected for 104 patients with T1N0M0 glottic squamous cell carcinoma who were treated and followed at our center in 1995-2013. Findings were compared between those with a tumor on the medial (n=60, 57.7%) or superior (n=44, 42.3%) aspect of the cords.ResultsMean follow-up time was 4.15 years. No between-group differences were found in demographic or risk factors. There was a significant association of anterior commissure involvement with disease recurrence (P=0.0012) and of superior (vs medial) location with higher rates of anterior commissure involvement (P <0.001) and recurrence (P=0.01) and shorter time to recurrence (P <0.001).ConclusionsT1 squamous cell carcinomas on the superior aspect of the vocal cords have a poorer prognosis than medial tumors and should be closely monitored for recurrence.

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Acellular dermal graft pharyngeal repair augmentation after laryngectomy

Publication date: Available online 2 February 2017
Source:American Journal of Otolaryngology
Author(s): Patrik Pipkorn, Parul Sinha, Joseph Zenga, Evan Graboyes, Bruce H. Haughey

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Effect of nebulized budesonide on decreasing the recurrence of allergic fungal rhinosinusitis

Publication date: Available online 1 February 2017
Source:American Journal of Otolaryngology
Author(s): Qi Dai, Chen Duan, Quan Liu, Hongmeng Yu
ObjectiveTo evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS (allergic fungal rhinosinusitis) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery.Subjects and methodsThirty patients were recruited into this study. Final diagnoses were reached using Bent and Kuhn's criteria. The patients were randomly divided into two groups: the budesonide transnasal nebulization group (group A) and the topical nasal steroids group (group B). Nasal symptoms, Lund-Mackay scores, and Kupferberg grades were evaluated before surgery, after surgery and during the follow-up to assess the effects of these two approaches.ResultsFour of the 15 patients in group B (26.67%) developed recurrent disease, whereas no patients in group A developed recurrent disease. This difference was statistically significant (p=0.032).ConclusionNebulized budesonide is an effective and safe treatment for patients with AFRS following endoscopic sinus surgery, as evidenced by the reduced recurrence rate observed in the budesonide transnasal nebulization group relative to the topical nasal steroids group.

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Role of Adenoidectomy in Chronic Nasal Obstruction After Nasal Steroid Therapy Failure

Publication date: Available online 2 February 2017
Source:American Journal of Otolaryngology
Author(s): Peter J. Ciolek, Allen Xu, Samantha Anne, Katie Geelan-Hansen
ObjectiveTo identify clinical characteristics of pediatric patients that failed nasal steroid therapy for management of chronic nasal obstruction and to evaluate the efficacy of adenoidectomy in this subset of patients.DesignRetrospective chart review.SettingTertiary care academic center.SubjectsAnalysis was performed on children that underwent adenoidectomy between 2011-2015 for chronic nasal obstruction refractory to nasal steroids.ResultsSeventy-four cases were identified. Average age of presentation was 3.6 years. Pre-operatively, 25.7% of patients had known asthma, 16.2% reported respiratory allergies, and 20.3% reported use of systemic antihistamines. The most common pre-operative symptoms included mouth breathing (82.4%), nasal congestion (81.1%), snoring (71.6%), and rhinorrhea (37.8%). Average adenoid size was 68% pre-operatively. Ninety-eight percent of patients experienced improvement or resolution of their symptoms following adenoidectomy.ConclusionsThis study demonstrates average rates of respiratory allergies, but high rates of asthma among patients that fail nasal steroid therapy for chronic nasal obstruction. Adenoidectomy is a highly efficacious intervention in this subset of patients.

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Rasagiline-induced severe recurrent hypoglycemia in a young woman without diabetes: a case report

We report a case of a patient with recurrent severe hypoglycemia after initiating the drug rasagiline (Azilect) for Parkinson disease.

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Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis

Publication date: Available online 2 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Ysa Karen dos Santos Macambira, Aline Tenório Lins Carnaúba, Luciana Castelo Branco Camurça Fernandes, Nassib Bezerra Bueno, Pedro de Lemos Menezes
IntroductionThe natural aging process may result in morphological changes in the vestibular system and in the afferent neural pathway, including loss of hair cells, decreased numbers of vestibular nerve cells, and loss of neurons in the vestibular nucleus. Thus, with advancing age, there should be a decrease in amplitudes and an increase in latencies of the vestibular evoked myogenic potentials (VEMP), especially the prolongation of p13 latency. Moreover, many investigations have found no significant differences in VEMP latencies with advancing age.ObjectiveTo determine if there are significant differences in the latencies of cervical VEMP (cVEMP) and ocular VEMP (oVEMP) between elderly and adult patients.MethodsThis is a systematic review with meta-analysis of observational studies, comparing the differences of these parameters between elderly and young adults, without language or date restrictions, in the following databases: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature databases: OpenGrey.eu and DissOnline, as well as Research Gate.ResultsThe n1 oVEMP latencies had a mean delay in the elderly of 2.32ms with 95% CI of 0.55–4.10ms. The overall effect test showed p=0.01, disclosing that such difference was significant. The heterogeneity found was I²=96% (p<0.001). Evaluation of p1 latency was not possible due to the low number of articles selected for this condition. cVEMP analysis was performed in 13 articles. For the p13 component, the mean latency delay in the elderly was 1.34ms with 95% CI of 0.56–2.11ms. The overall effect test showed a p<0.001, with heterogeneity value I²=92% (p<0.001). For the n23 component, the mean latency delay for the elderly was 2.82ms with 95% CI of 0.33–5.30ms. The overall effect test showed p=0.03. The heterogeneity found was I²=99% (p<0.001).ConclusionThe latency of oVEMP n1 wave component and latencies of cVEMP p13 and n23 wave components are longer in the elderly aged >60 years than in young adults.

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Neutrophil perversion in demyelinating autoimmune diseases: Mechanisms to medicine

Publication date: Available online 2 February 2017
Source:Autoimmunity Reviews
Author(s): Courtney S. Casserly, Julia C. Nantes, Ryder F. Whittaker Hawkins, Luc Vallières
Neutrophils are essential to a healthy life, yet pose a threat if improperly controlled. Neutrophil perversion is well documented in a variety of inflammatory disorders (e.g. arthritis, lupus, psoriasis), but is only beginning to be demystified in autoimmune demyelination, the most common cause of neurological disability in young adults. Using the animal model experimental autoimmune encephalomyelitis (EAE), several molecules that help neutrophils invade the central nervous system (CNS) have been identified. Mechanisms by which neutrophils may contribute to demyelination have also been proposed (e.g. secretion of endothelial/leukocytic modulators, antigen presentation to T cells, myelin degradation and phagocytosis). In human, neutrophils are seen in the CNS of people with neuromyelitis optica spectrum disorder and other severe variants of autoimmune demyelinating diseases. At the time of autopsy for multiple sclerosis (MS) — often many years after its onset — neutrophils appear to have escaped the scene of the crime. However, new clues implicate neutrophils in MS relapses and progression. This warrants further investigating 1) the differential importance of neutrophils among demyelinating diseases, 2) the largely unknown effects of current MS therapies on neutrophils, and 3) the potential of neutrophil proteins as clinical biomarkers or therapeutic targets.

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Autoimmune hepatitis and occult HCV infection: A prospective single-centre clinical study

Publication date: Available online 1 February 2017
Source:Autoimmunity Reviews
Author(s): Roee Dvir, Giuseppe Andrea Sautto, Nicasio Mancini, Sara Racca, Roberta Antonia Diotti, Massimo Clementi, Massimo Memoli

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Study of Pembrolizumab (MK-3475) or Placebo With Chemoradiation in Participants With Locally Advanced Head and Neck Squamous Cell Carcinoma (MK-3475-412/KEYNOTE-412)

Condition: Head and Neck Neoplasms
Interventions: Biological: Pembrolizumab; Drug: Placebo; Drug: Cisplatin; Radiation: Accelerated Fractionation (AFX) Radiotherapy; Radiation: Standard Fractionation (SFX) Radiotherapy
Sponsor: Merck Sharp & Dohme Corp.
Not yet recruiting - verified February 2017

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Gain-of-function STAT1 mutations are associated with intracranial aneurysms

Publication date: Available online 2 February 2017
Source:Clinical Immunology
Author(s): Mete Dadak, Roland Jacobs, Jelena Skuljec, Adan Chari Jirmo, Özlem Yildiz, Frank Donnerstag, Niklas Thomas Baerlecken, Reinhold Ernst Schmidt, Heinrich Lanfermann, Thomas Skripuletz, Philipp Schwenkenbecher, Christoph Kleinschnitz, Hayrettin Tumani, Martin Stangel, Refik Pul
Chronic mucocutaneous candidiasis, characterized by persistent or recurrent fungal infections, represents the clinical hallmark in gain-of-function (GOF) signal transducer and activator of transcription 1 (STAT1) mutation carriers. Several cases of intracranial aneurysms have been reported in patients with GOF STAT1 mutation but the paucity of reported cases likely suggested this association still as serendipity. In order to endorse this association, we link the development of intracranial aneurysms with STAT1 GOF mutation by presenting the two different cases of a patient and her mother, and demonstrate upregulated phosphorylated STAT4 and IL-12 receptor β1 upon stimulation in patient's blood cells. We also detected increased transforming growth factor (TGF)-β type 2 receptor expression, particularly in CD14⁺ cells, and a slightly higher phosphorylation rate of SMAD3. In addition, the mother of the patient developed disseminated bacille Calmette-Guérin disease after vaccination, speculating that GOF STAT1 mutations may confer a predisposition to weakly virulent mycobacteria.

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Anti-BlyS antibody reduces the immune reaction against enzyme and enhances the efficacy of enzyme replacement therapy in Fabry disease model mice

Publication date: Available online 2 February 2017
Source:Clinical Immunology
Author(s): Yohei Sato, Hiroyuki Ida, Toya Ohashi
Formation of antibodies against a therapeutic enzyme is an important complication during enzyme replacement therapy (ERT) for lysosomal storage diseases. Fabry disease (FD) is caused by a deficiency of alpha-galactosidase (GLA), which results in the accumulation of globotriaosylceramide (GL-3). We have shown immune tolerance induction (ITI) during ERT in FD model mice by using an anti-B lymphocyte stimulator (anti-BlyS) antibody (belimumab). A single dose of the anti-BlyS antibody temporarily lowered the percentage of B cells and IgG antibody titer against recombinant human GLA. Administration of a low maintenance dose of the anti-BlyS antibody suppressed the B cell population and immunotolerance was induced in 20% of mice, but antibody formation could not be prevented. We then increased the maintenance dose of the anti-BlyS antibody and immunotolerance was induced in 50% of mice. Therapeutic enzyme distribution and clearance of GL-3 were also enhanced by a high maintenance dose of the anti-BlyS antibody.

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A novel mutation in TAP1 gene leading to MHC class I deficiency: Report of two cases and review of the literature

Publication date: Available online 2 February 2017
Source:Clinical Immunology
Author(s): Damla Hanalioglu, Deniz Cagdas Ayvaz, Tuba Turul Ozgur, Mirjam van der Burg, Ozden Sanal, Ilhan Tezcan
Major histocompatibility complex (MHC) class I deficiency syndrome is a rare primary immunodeficiency caused by mutations in the peptide transporter complex associated with antigen presentation (TAP) gene which plays a crucial role in intracellular peptide antigen presentation. A few cases have been reported to date. Recurrent sinopulmonary infections and skin ulcers are main characteristics of the syndrome. Here we report two siblings diagnosed with TAP1 deficiency syndrome associated only with recurrent sinopulmonary infections with the description of a novel mutation leading to a premature stop codon in TAP1 gene and review of the relevant literature. Both of the siblings had recurrent sinopulmonary infections since childhood, responded to antibiotherapy well, neither of them had hospitalization history because of infections. One had chronic hepatitis B infection which may possibly be related to TAP1 gene defect.

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Lung consolidation responding to chemotherapy

Consolidations in the pulmonary parenchyma are mostly infective, although they can rarely be due to autoimmune and neoplastic processes. Consolidations, especially in the setting of underlying immunosuppressive haematological malignancy, are usually presumed infective by the treating physician. Pulmonary involvement in chronic lymphocytic leukaemia presenting as consolidations and type 1 respiratory failure, responding to systemic chemotherapy, is a rare and uncommon presentation.

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Renal cell carcinoma metastasis involving vertebral hemangioma: dual percutaneous treatment by navigational bipolar radiofrequency ablation and high viscosity cement vertebroplasty

The case of a 70-year-old woman with progressive renal cell carcinoma (RCC) metastatic invasion of a L3 vertebral hemangioma treated by dual percutaneous radiofrequency ablation (RFA) and vertebroplasty is reported. The patient was surgically treated for RCC in 2001. Chemotherapy and immunotherapy were introduced in 2013 for ovarian, bladder and cerebral metastatic disease. An asymptomatic L3 benign hemangioma was noticed at this time. One-year CT and MRI follow-up studies demonstrated a nodular isolated soft tissue lesion involving the anterior edge of the hemangioma. Percutaneous treatment consisted of a L3 vertebral body unipedicular approach to perform a biopsy, RFA with a navigational bipolar RFA device and vertebroplasty using high viscosity cement. Histopathological examination confirmed metastasis of RCC. The 5-month spinal MRI and CT examinations demonstrated complete disappearance of the tumor.

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Pregnancy in a patient with congenital analbuminaemia

Congenital analbuminaemia is a rare autosomal recessive disorder that is characterised by a severe reduction or total absence of serum albumin. This condition has implications for therapeutics as a large proportion of commonly used drugs are plasma protein bound where albumin is the primary component of plasma protein. This is the first case report of pregnancy in a patient with congenital analbuminaemia in the medical literature. In the absence of drug dosage guidelines for patients with congenital analbuminaemia, a list of drugs which may be required for this patient during pregnancy, delivery and/or emergency situations were compiled by a multidisciplinary team. Our patient suffered from polyhydramnios during her pregnancy which was successfully managed with albumin transfusions and had a normal vaginal delivery with no complications in the intrapartum or postpartum period. The management and unique challenges of pregnancy in a patient with congenital analbuminaemia are discussed.

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New functions of lysosomes in bone cells

Publication date: Available online 2 February 2017
Source:Journal of Oral Biosciences
Author(s): Takayuki Tsukuba, Eiko Sakai, Kazuhisa Nishishita, Tomoko Kadowaki, Kuniaki Okamoto
BackgroundLysosomes are intracellular acidic organelles that contain approximately 50 hydrolases and 25 species of integral membrane proteins. Although lysosome-like specific compartments, termed lysosome-related organelles (LROs), are found in osteoclasts, their functions in these cells and lysosomal functions in osteoblasts remain to be elucidated.HighlightRecently, we found that expression of RAB27A is markedly increased during osteoclastic differentiation. RAB27A deficiency causes multinucleation and giant cell formation, characterized by abnormal transport of cell surface receptors and LROs into osteoclasts. Furthermore, we have shown that transcription factor EB (TFEB), a master regulator of lysosomal biogenesis, regulates osteoblastic differentiation. Overexpression of TFEB in preosteoblastic MC3T3-E1 cells enhances osteoblastic differentiation via decreased expression of activating transcription factor 4 (ATF4) and CCAAT/enhancer-binding protein homologous protein (CHOP). These results indicate that the expression of ATF4 and CHOP is essential for differentiation into osteoblasts.ConclusionRAB27A participates in bone resorption by LROs in osteoclasts. In addition, lysosomal biogenesis modulated by TFEB is necessary for osteoblastic differentiation.

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Ex vivo humidifying capacity and patient acceptability of stoma cloths in laryngectomized individuals

ABSTRACT

Background

Heat and moisture exchangers (HMEs) improve respiratory function after laryngectomy, but there is virtually no information on the benefit of traditional stoma cloths or other covers.

Methods

Two sequential studies were performed: (1) an ex vivo test was used to compare the humidifying capacity of stoma cloths to other coverings; and (2) a 4-week randomized trial was then performed to assess patient acceptability of cloths both alone and with an HME (N = 18).

Results

The humidifying capacity of the coverings tested varied widely. For stoma cloths, a humidifying capacity of 13.7 mg/L was found to decrease to 8.5 mg/L if air-leaks around the cloth occurred. Patients who used HMEs disliked stoma cloths because they interfered with voicing, they became soiled more easily, and were less effective at reducing coughing and mucus production.

Conclusion

Although less acceptable to patients who use an HME, stoma cloths do provide significant humidifying capacity and should be encouraged when HMEs are unavailable or inappropriate. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Effect of prophylactic percutaneous endoscopic gastrostomy tube on swallowing in advanced head and neck cancer: A randomized controlled study

ABSTRACT

Background

Dysphagia is common in head and neck cancer. A percutaneous endoscopic gastrostomy (PEG) tube is used to facilitate nutrition; however, some retrospective studies have indicated that the PEG tube causes dysphagia.

Methods

A randomized study of patients with head and neck cancer was conducted with up to 10 years of follow-up. Patients were randomized to either the prophylactic PEG tube group (study group) or the common clinical nutritional support group (control group). At each follow-up, a dietician assessed the oral intake, noted the patients' weight, and if the patients used a PEG tube. Dysphagia was also assessed by the quality of life questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (EORTC-QLQ-H&N35).

Results

One hundred thirty-four patients were included in this study. There was no significant difference in swallowing function between the groups after 12 months, 24 months, and 8 years based on the EORTC-QLQ-H&N35, the oral intake scale, tube dependence, esophageal intervention, weight, body mass index (BMI), and overall survival.

Conclusion

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Complementary role of the Memorial Sloan Kettering Cancer Center nomogram to the American Joint Committee on Cancer system for the prediction of relapse of major salivary gland carcinoma after surgery

ABSTRACT

Background

The purpose of this study was to test the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram in predicting recurrence risk of major salivary gland carcinoma in an Asian cohort.

Methods

We retrospectively enrolled 149 patients who had undergone intended curative resections for major salivary gland carcinoma between 2007 and 2012. The performance of the MSKCC nomogram and the American Joint Committee on Cancer (AJCC) seventh staging system in predicting recurrence risk was compared.

Results

The MSKCC nomogram and the AJCC staging system both accurately predicted the 5-year recurrence probabilities, with the concordance index (c-index = 0.82; 95% confidence interval [CI], 0.75–0.89 vs c-index, 0.77; 95% CI, 0.68–0.87; p = .45) in patients with major salivary gland carcinomas after curative surgeries. Comparing to the actual observed events, the calibration plot indicated that the MSKCC nomogram accurately estimated the recurrence in low-risk groups but tended to overestimate in high-risk groups. When using the MSKCC nomogram to predict the 5-year recurrence-free probability in each AJCC stage, the prediction was very good for patients with AJCC stages I and II disease (c-index = 0.92 and 0.90, respectively) and modest for those of AJCC stages III and IVa (c-index = 0.51 and 0.62, respectively).

Conclusion

The MSKCC nomogram and the AJCC staging system each had its value in predicting recurrence of major salivary gland cancers. When using the MSKCC nomogram to predict the 5-year recurrence-free probability in each AJCC stage, the MSKCC nomogram was more accurate in predicting recurrence risks in those patients with AJCC stage I and II diseases than those with late-stage diseases. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Tailored approach to oromandibular reconstruction in patients with compromised lower limb vessels

ABSTRACT

Background

The purpose of this study was to compare outcomes for segmental reconstruction of the mandible between patients who underwent reconstruction with a fibula flap (group 1), and those with an alternative osseous free flap in which the fibula flap was unsuitable either for defect reasons (group 2) or in which the fibula flap could not safely be harvested because of compromised leg vessels (group 3).

Methods

One hundred fifty-two patients who underwent osseous free flap reconstruction of a mandibular segmental defect between January 2008 and June 2014 were identified from operating records. Outcomes between groups was compared.

Results

The flap success rate was 97% and the late recipient-site complication rate was 19%. There was no difference in flap success or complication rates between groups.

Conclusion

Bony reconstruction of the mandible can be achieved with no compromise in flap success even where preoperative vascular studies or the nature of the defect deem the fibula unsuitable. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Biomarkers for Monitoring Clinical Efficacy of Allergen Immunotherapy for Allergic Rhinoconjunctivitis and Allergic Asthma: an EAACI Position Paper

Abstract

Allergen immunotherapy (AIT) is an effective treatment for allergic rhinoconjunctivitis (AR) with or without asthma (1-12). AIT has disease modifying properties and confers long-term clinical benefit after cessation of treatment (6, 7, 13-17). AIT is routinely used in daily practice and can be administered either subcutaneously (SCIT) or sublingually (SLIT) (3-12). Although AIT is effective, the degree of remission strongly varies depending on the complex interaction between patient, allergy, symptomatology and vaccines used for AIT (3-9). Clinical management of patients receiving AIT and efficacy in randomised controlled trials for drug development could be significantly enhanced if there were means to identify those who are most likely to respond, when to stop treatment, how to predict relapse and when to perform booster AIT. Furthermore, biomarkers in AIT can play a central role in personalized medicine (18).

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Efficacy of oral diclofenac with or without codeine for pain control after invasive bilateral third molar extractions

Publication date: Available online 1 February 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Zupelari-Goncalves, G.M. Weckwerth, A.M. Calvo, L.F. Simoneti, T.J. Dionisio, D.T. Brozoski, E.A. Torres, J.R.P. Lauris, F.A.C. Faria, C.F. Santos
Postoperative pain and inflammation after oral surgery is mostly managed using non-steroidal anti-inflammatory drugs (NSAIDs). However, opioids combined with NSAIDs may improve pain management in patients, especially after traumatic oral surgery. Few studies have compared NSAIDs with and without opioid use after oral and maxillofacial surgery. This randomized, double-blind, cross-over study compared the clinical efficacy of either diclofenac (50mg) and codeine (50mg) or diclofenac alone (50mg) for the management of postoperative pain after invasive third molar surgery. Volunteers (n=46) who were scheduled to undergo the removal of symmetrically positioned lower third molars in two separate appointments were included. They reported significantly less postoperative pain at various time points within 24h after surgery and also consumed significantly less rescue medication (paracetamol (acetaminophen)) throughout the study when they took diclofenac combined with codeine than when they took only diclofenac. In conclusion, oral diclofenac with codeine was more effective for managing postoperative pain than diclofenac without codeine. It was expected that patients taking two pain medications after surgery would generally have less pain than when taking only one of the two medications. The prospective cross-over design of the present work makes this study distinct from many others.

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Temporomandibular total joint prosthesis infections: a ten-year retrospective analysis

Publication date: Available online 1 February 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): W.S. McKenzie, P.J. Louis
A retrospective review of 178 total temporomandibular joint replacements (TJR) performed on 106 patients at the University of Alabama at Birmingham during the years 2000–2010 was completed. Data regarding sex, past medical history, prosthesis manufacturer, microbiology, antibiotic therapy, and the need for additional procedures were obtained from the medical records of patients who developed a prosthetic joint infection following TJR. Of the 106 patients, 95 (89.6%) were female and 11 (10.4%) were male. The average age of the patients was 47 years (range 19–68 years). Sixty patients underwent bilateral TJR. The average length of follow-up was 41 months. Of the 178 TJR performed, eight joints (4.5%) developed an infection of the prosthesis, all requiring removal despite antibiotic therapy. The average time to onset of infection was 14.3 months (range 6 days to 72 months), while the average time to removal of the prosthesis was 26.9 months (range 10 weeks to 84 months). Microbiology data from the infected joints revealed colonization with coagulase-negative Staphylococcus (4/8 joints) and Propionibacterium (2/8 joints), as well as Serratia and Peptostreptococcus species. Three of the prostheses had negative cultures.

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Revisión de nuestra experiencia en fonocirugía infantil

Publication date: Available online 1 February 2017
Source:Acta Otorrinolaringológica Española
Author(s): Mikel Landa, Idoia Palicio, Leire Álvarez, Zuriñe Martínez
Introducción y objetivosLa disfonía es un problema frecuente en los niños, especialmente en edad escolar. La exploración de las cuerdas vocales suele ser más difícil y menos precisa que en los adultos. La lesión que más a menudo encontramos en niños con disfonía crónica son los nódulos vocales, seguido de los quistes epidermoides y de las demás lesiones congénitas, como sulcus y puente mucoso. El tratamiento es multidisciplinar y se basa fundamentalmente en rehabilitación vocal. Indicamos tratamiento quirúrgico en niños mayores de 9 años en los que persiste el problema tras la rehabilitación, sobre todo si sospechamos una lesión congénita de la cuerda vocal.MétodosPresentamos un estudio retrospectivo de la fonocirugía infantil realizada en nuestro hospital durante 9 años (2005-2013). Se incluye a 51 niños, con edades comprendidas entre los 9 y los 16 años. Analizamos la distribución de las diferentes lesiones, tanto congénitas como adquiridas. Evaluamos los resultados mediante la valoración subjetiva de los familiares de los niños intervenidos.ResultadosObtuvimos una distribución del 76% (n=39) de lesiones congénitas y un 24% (n=12) de lesiones adquiridas. Encontramos un porcentaje global de mejoría tras la cirugía del 90%, con mejores resultados en los nódulos vocales, aunque sin alcanzar significación estadística.ConclusionesLa valoración de los resultados de esta cirugía es controvertida y en este estudio se hace con una única pregunta a los familiares. Encontramos un resultado global de mejoría en el 90% de los casos intervenidos, sin ninguna complicación. Tenemos mejores resultados con los nódulos vocales, aunque no alcanzan significación estadística.Introduction and objectivesDysphonia is a common problem in children, especially those of school age. Exploration of vocal folds is often difficult and less accurate in children. The most frequent lesions found in children with chronic dysphonia are vocal nodules, followed by epidermoid cysts and other congenital lesions, such as sulci and mucosal bridges. The treatment is multidisciplinary and it is fundamentally based on vocal rehabilitation. We indicate surgical treatment in children older than 9 years of age for whom the problem persists after rehabilitation, especially if we suspect a congenital lesion of the vocal fold.MethodsWe present a retrospective study of paediatric phonosurgery performed by the Vocal Pathology Unit of our Hospital over a period of 9 years (2005-2013). Fifty-one children were included, ranging in age from 9 to 16 years old. We analyzed the distribution of the different lesions, both congenital and acquired. We evaluated the results by subjective evaluation by the children's relatives.ResultsWe obtained a distribution of 76% (n=39) of congenital lesions and 24% (n=12) of acquired lesions. After surgery, there was a global percentage of improvement of 90%, with better results in cases of vocal nodules, without statistical significance.ConclusionsThe evaluation of the results of this surgery is controversial and in this study is done with a single question survey administered to relatives. We found an overall result of improvement in 90% of operated cases, without any complications. We obtained better results in vocal nodules, although not reaching statistical significance.

http://ift.tt/2jAoT86

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma

Publication date: Available online 1 February 2017
Source:Allergologia et Immunopathologia
Author(s): I. Asher, T. Haahtela, O. Selroos, P. Ellwood, E. Ellwood
BackgroundSeveral countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world.MethodsThe Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013–2014. One of the questions was: "Has a national asthma strategy been developed in your country for the next five years? For children? For adults?".ResultsInvestigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p<0.001).InterpretationIn 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy.

http://ift.tt/2k3sEBr

Use of anti-allergic drugs in children

Publication date: Available online 1 February 2017
Source:Allergologia et Immunopathologia
Author(s): C. Suárez-Castañón, G. Modroño-Riaño, G. Solís-Sánchez
Allergic rhinitis is one of the most frequent chronic diseases in children. We have analysed the prescriptions habits of anti-allergic medications in children (<14 years old) in 2011. We calculated the DHD (N°DDD/1000 children/day) for oral antihistamines and intranasal therapies (corticoids and antihistamines) in the region (sanitary districts I–VIII) and specifically in sanitary district V (health centres 1–15). We also reviewed the clinical records in six health centres in sanitary district V to know more details about age and diagnosis and to value if these prescriptions are adequate. We observed a use of 8.78 DHD in the group of oral antihistamines, with a predominance of desloratadine (3.48 DHD), a 3rd generation drug of this group, and in second place the intranasal therapy with a preference of corticoids (budesonide 3.5 DHD and mometasone 2.25 DHD). We think that it is necessary to improve the knowledge of anti-allergic drugs in children.

http://ift.tt/2jZsR6d

Allergy genuflection? It's surmount with special focus on ear, nose and throat

Publication date: Available online 1 February 2017
Source:Allergologia et Immunopathologia
Author(s): D. Gupta, L. Deshmukh, R. Gupta, S.S. Sandhu
The system that protects body from infectious agents is immune system. On occasions, the system seldom reacts with some foreign particles and causes allergy. Allergies of the ear, nose and throat (ENT) often have serious consequences, including impairment and emotional strain that lowers the quality of life of patients. This is further responsible for the common cold, cough, tonsillitis, dermal infection, chest pain and asthma-like conditions which disturb one's day to day life. The present review enlightens some common ENT allergies which one can suffer more frequently in one's lifetime, and ignorance leads to making the condition chronic. Information regarding pathophysiology and the management of ENT allergy by this review could help clinicians and common people to better understand the circumstances and treatment of ENT allergy.

http://ift.tt/2k3vh6F

Bacillus Calmette–Guérin vaccine complications in Iranian children at a University Hospital

Publication date: Available online 1 February 2017
Source:Allergologia et Immunopathologia
Author(s): M.R. Bolursaz, F. Lotfian, A.A. Velayati
BackgroundAlthough the BCG vaccine remains the only available vaccine, a number of complications from local to systemic adverse reactions can occur.ObjectiveThe aim of the study was to review the clinical features and treatment of Bacillus Calmette–Guérin (BCG) complications in children.MethodsChildren with clinical and laboratory findings compatible with a diagnosis of local complication and disseminated disease at Masih Daneshvari Medical Center were enrolled from March 2013 to September 2015.ResultsAmong 49 children with BCG complications, 35 (71%) had local complications and 14 (29%) had disseminated disease. The mean age at presentation was nine months (range: 1m–13y). The male to female ratio was 1.7:1. Suppurative lymphadenitis was seen in 25 of 35 (71%) cases. Among cases with disseminated disease, primary immunodeficiency (PID) was identified in nine (64%) cases. All cases with non-suppurative lymphadenitis were managed conservatively. Twenty (80%) cases with suppurative lymphadenitis were managed differently with medical treatment or surgery. In disseminated cases, three (43%) were treated with only medical treatment and eight (57%) with both medical and surgical treatment.ConclusionsMost children with BCG complications had a local disease in our study. A higher rate of disseminated disease was also observed. In addition, PID was identified in most children with disseminated disease. Development of more appropriate BCG vaccines and changing the current vaccination programme in cases with suspected PID are required in our country.

http://ift.tt/2jZkrMu

Our current practice of ‘group and save’ blood for nasopharyngeal tumour biopsy (NB), and to determine the rate of blood transfusions among patients who underwent NB under general anaesthesia

Is 'Group and Save' Blood Request Routinely Required for Nasopharyngeal Biopsy?

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Nuclear erythroid 2-related factor 2 activation inhibits house dust mite–induced sinonasal epithelial cell barrier dysfunction

Background

Dysregulated sinonasal epithelial cell (SNEC) barrier function has been proposed to contribute to the pathogenesis of sinonasal inflammatory conditions such as allergic rhinitis (AR) and chronic rhinosinusitis (CRS). Allergens such as house dust mite (HDM) have been reported to disrupt SNEC barrier integrity. We have recently identified nuclear erythroid 2-related factor 2 (Nrf2) activation via sulforaphane (SFN) stimulation to stabilize SNEC barrier function. The purpose of this study was to explore whether Nrf2 activation could ameliorate HDM-induced SNEC barrier dysfunction.

Methods

Human SNECs (HSNECs) were grown from patients at the air-liquid interface (ALI). HSNECs were stimulated with HDM with or without pharmacologic activation of Nrf2 with SFN. HSNECs were then stained for the epithelial cell junction protein zonula occludens-1 (ZO-1) and cell surface localization was evaluated by confocal microscopy. Transepithelial electrical resistance (TER) and paracellular fluorescein isothiocyanate (FITC)-dextran permeability was measured in response to stimulation with HDM and SFN.

Results

HDM stimulation caused a global disruption of the protein ZO-1 along with an associated decrease in TER (p < 0.001) and increased FITC-dextran paracellular permeability (p < 0.0001). Enhancing Nrf2 activation through treatment with SFN prior to stimulation with HDM was associated with increased localization of ZO-1 at the cell surface and statistically significant increases in TER (p < 0.05) and decrease in paracellular FITC-dextran permeability (p < 0.001).

Conclusion

This is the first study to demonstrate that HDM-induced SNEC barrier dysfunction may be preventable by Nrf2 activation. The Nrf2 antioxidant pathway may represent a potential therapeutic target for allergen-induced sinonasal inflammation.

http://ift.tt/2jA93dG

Nonadherence to sublingual immunotherapy in allergic rhinitis: a real-life analysis

Background

To sustain the long-lasting beneficial effects of allergen-specific sublingual immunotherapy (SLIT), an adequate duration of treatment is required. Nevertheless, many patients discontinue prematurely and therefore fail to obtain satisfactory therapeutic effect in clinical practice. The aim of this study was to analyze the causes leading to premature discontinuation of SLIT in allergic rhinitis (AR), and to provide the corresponding countermeasures for the following SLIT course.

Methods

We performed a retrospective analysis of data from 142 patients with AR who started SLIT during the period from December 2009 to February 2015. Patients were contacted at 1, 3, 6, and 12 months into SLIT as part of our standard of care. The patients who claimed to have stopped treatment were asked to provide a reason during one of the phone calls.

Results

Overall, 76 (54%) patients with AR terminated immunotherapy during the first year of treatment. Among the 76 patients, the following reasons were cited for nonadherence to immunotherapy: patients could not be reached (25%); ineffectiveness (24%); the long course (18%); improvement of symptoms (13%); side effects (4%); lack of confidence in the treatment (4%); or other reasons (12%).

Conclusion

Fifty-four percent of AR patients terminated their treatment within the first year of SLIT. The top reasons for treatment discontinuation included patients not be reached, ineffectiveness, and length of course.

http://ift.tt/2jGQfEV

Safety of long-term intranasal budesonide delivered via the mucosal atomization device for chronic rhinosinusitis

Background

Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP).

Methods

A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related to corticosteroid use. Treatment adherence was subjectively assessed using a medication adherence scale (MMAS-8) to evaluate the validity of steroid exposure estimates.

Results

A total of 100 CRS patients were recruited with a mean budesonide treatment duration of 23.5 months (range, 6–37 months). Stimulated cortisol response was diminished in 3 patients (3%). No patients with adrenal suppression had relevant symptomatology. IOP was elevated in 6 patients (6%). A mean MMAS-8 score of 6.8 indicated moderate-to-high treatment adherence behavior among this population.

Conclusion

These findings suggest that there is a risk of adrenal suppression and raised IOP associated with the long-term use of topical nasal budesonide via MAD. Otolaryngologists should consider periodic surveillance for these adverse events in this patient cohort.

http://ift.tt/2jAm9aL

Interleukin-10 family cytokines pathway: genetic variants and psoriasis

Summary

Background

Interleukin (IL)-10 family cytokines IL-10, IL-19, IL-20, and IL-24 have been implicated in autoimmune diseases and we have previously reported that genetic variants in IL10 gene cluster were associated with psoriasis.

Objective

To analyze the relationship of genetic polymorphisms in the IL10 gene cluster with psoriasis. This study also explores whether there are gene–gene interactions among these genetic polymorphisms.

Methods

A total of 377 patients with psoriasis and 403 matched healthy controls were enrolled to carry out a case-control study for 48 SNPs of IL10 gene cluster. Genotyping for the SNPs was conducted on the Applied Biosystems 3730 DNA Analyzer using SNPlex^™ technology. Generalized multifactor dimensionality reduction (GMDR) analysis was applied to discover likely gene–gene interaction model among the SNPs.

Results

The results showed that the alleles distributions of IL10 gene cluster SNPs are significantly different between case and control groups. Carriers of IL10 T allele (rs1554286) and of IL20 T allele (rs1400986) conferred protection to psoriasis (OR = 0.63, Pc = 0.007; OR = 0.62, Pc = 0.038, respectively). GMDR analysis displayed a significant gene-gene interaction between IL10 (rs1554286) and IL20 (rs1518108) variants. The strongest protective effect was found with the block 1 haplotype ACATA in the IL10 gene (Pc = 0.004).

Conclusions

The novel finding of the present study is gene-gene interaction of the IL-10 pathway on the reduced risk of psoriais. Our results indicate that genetic variants of the immunomodulatory IL10 and IL20 genes may protective effect in the Europeans from Russia. Independent studies are needed to verify the results and find the possible functional explanation.

http://ift.tt/2jYS4xS

A Phase 1 clinical trial demonstrates nfP2X7 targeted antibodies provide a novel, safe and tolerable topical therapy for BCC

Abstract

Background

Expression of P2X₇, an ATP gated calcium channel, increases cancer cell proliferation and invasiveness. A variant of P2X₇ (termed nfP2X₇), in which a normally hidden epitope (E200) is exposed for antibody binding, is observed in a variety of different cancers.

Objectives

To investigate the safety, tolerability and pharmacokinetics and assess indicative efficacy of a novel antibody ointment as a therapeutic for BCC.

Methods

An open label, Phase 1 clinical trial was undertaken at 3 dermatology clinics to evaluate the safety and tolerability of topical administration of an ointment containing 10% sheep polyclonal anti-nfP2X₇ antibodies (BIL010t) to primary BCC lesions twice daily for 28 days. Twenty one patients with primary BCC lesions at least 0.5cm² in area and less than 2.0cm in diameter were enrolled. The primary endpoints were safety, tolerability and pharmacokinetics (PK).Change in lesion size after treatment was determined and histology was performed on pre-treatment and End of Treatment (EOT) biopsies.

Results

Compliance was very high, with treatment being well-tolerated. The most common adverse events were treatment site erythema, pruritus, dryness and pain. There was no evidence of systemic penetration of the sheep antibody. Lesions were measured prior to and after 28 days treatment, with 65% of patients showing a reduction in lesion area, 20% no change and 15% an increase. Histopathology of post-treatment excision of lesion sites showed 8 patients with stable disease, 9 with partial response and 3 with complete response.

Conclusions

Antibodies against nfP2X₇ (BIL010t) provide a novel, safe and well tolerated treatment for BCC.

http://ift.tt/2k2Yu1g

Lack of evidence for prognostic value of epidermal growth factor receptor intron-1 CA repeats for oral carcinomas

Epidermal growth factor receptor (EGFR) expression is altered in several malignancies, including oral squamous cell carcinoma. A CA-repeat polymorphism in intron-1 (CA-SSR-1) of the EGFR gene is reported to influence EGFR expression and is associated with features of various solid tumors and outcomes of cancer patients. In the present study we evaluated the influence of length and zygosity of CA-SSR-1 on the survival of patients with oral squamous cell carcinoma. The length and zygosity of CA-SSR-1 was obtained through microsatellite analysis in 91 patients with oral cancer, who were treated in the Department of Oral and Maxillofacial Surgery of the University Medical Centre Hamburg Eppendorf, Germany, during the years 1998–2008. Follow up was conducted until 2016. Outcome measures were age, gender, tumor stage, occurrence of metastases, and date of recurrence or death. Statistical analysis was conducted using the chi-square test and the log-rank test. Neither length nor zygosity of the CA-SSR-1 in patients with oral squamous cell carcinoma was significantly correlated with sex, age, tumor size, tumor localization, lymph node involvement, metastasis status, disease-free survival, or overall survival. Length and zygosity of the CA-SSR-1 polymorphism in EGFR is not able to serve as a prognostic biomarker in White European patients with oral squamous cell carcinoma.

http://ift.tt/2jGAVbe

Making the Connection

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 41-year-old man with a weight of…

http://ift.tt/2kk72iM

Interstitial granulomatous dermatitis associated with rheumatoid arthritis

http://ift.tt/2kvaWI1

Case of childhood polymorphous light eruption provoked by overlap exposure to ultraviolet A and B radiation

http://ift.tt/2kZaZc3

Dermoscopic features of nail psoriasis treated with biologics

Abstract

Although psoriatic nail lesions are small, they cause considerable discomfort for patients and adversely affect quality of life. Few studies have evaluated the dermoscopic features of psoriatic nails. The aim of this study was to clarify the dermoscopic features of nail psoriasis and identify those that reflect psoriatic activity. During biologic treatment of psoriasis, six patients with psoriatic nails twice underwent dermoscopic examination, with an interval of 17–42 weeks. We used the modified Nail Psoriasis Severity Index score and Psoriasis Area and Severity Index score to identify and assess dermoscopic features. We identified 10 dermoscopic findings, of which disappearance of diffuse scaling of the nail plate, transverse step-like notches and splinter hemorrhages of the nail bed, and appearance of erythematous borders of the onycholytic area were associated with improvement in Psoriasis Area and Severity Index score. Dermoscopy can detect nail changes during psoriasis treatment and should be used to evaluate treatment success.

http://ift.tt/2kvaWrv

Application of COL1A1–PDGFB fusion gene detection by fluorescence in situ hybridization in biopsy tissue of dermatofibrosarcoma protuberans

Abstract

Several uncommon variants of dermatofibrosarcoma protuberans (DFSP) and the limitations of small biopsies render pathological diagnosis difficult. The aim of this study was to analyze the utility of fluorescence in situ hybridization (FISH) in the detection of the collagen type I-α1/platelet derived growth factor-β (COL1A1–PDGFB) fusion gene in biopsies of DFSP. Twenty-three consecutive biopsy specimens of DFSP were reviewed for clinicopathological features and examined with the COL1A1–PDGFB fusion probe and PDGFB break-apart probe using FISH analysis. The 23 tumor samples consisted of 11 males and 12 females (mean age at diagnosis, 37 years; range, 14–75 years). Eighteen conventional DFSP, one Bednar tumor, two myxoid DFSP and two fibrosarcomatous DFSP samples were included in the group. Strong and extensive CD34 expression was observed in 19 of 23 cases (83%). Twenty-one cases (91%) were positive for both the COL1A1–PDGFB fusion signal and the PDGFB break-apart signal. This is one of the few studies to demonstrate the value of FISH analysis of the COL1A1–PDGFB gene, which could validate complicated and suspected diagnoses in the routine biopsy of DFSP.

http://ift.tt/2kZbiDv

Four cases of Morbihan disease successfully treated with doxycycline

Abstract

Morbihan disease (MD) is rosacea-like disease characterized by persistent lymphedema on the upper half of the face. Currently, there is no established standard treatment for MD. Recently, MD has been reported to be associated with the infiltration of mast cells. The aim of this study was to investigate the association of treatment response and mast cell infiltration in MD. We report four cases of MD that were successfully treated with long-term oral doxycycline therapy.

http://ift.tt/2kvaVUt

Pemphigus foliaceus developed in a patient with long-term erosion on the genital skin

http://ift.tt/2kYZtgC

Serum cytokeratin 19 fragment 21-1 is a useful tumor marker for the assessment of extramammary Paget's disease

Abstract

Cytokeratin 19 fragment 21-1 (CYFRA 21-1) has been used as a tumor marker for several malignancies. However, to date, no studies have assessed whether CYFRA 21-1 could be a useful marker for extramammary Paget's disease (EMPD). The present study aimed to evaluate the significance of CYFRA 21-1 as a serum tumor marker for EMPD progression. Concentrations of serum CYFRA 21-1 and carcinoembryonic antigen (CEA) in 13 cases of EMPD were measured prior to undergoing treatment at Sapporo Medical University Hospital from January 2014 to May 2016. Four of the 13 patients had lymph node metastases at diagnosis, but none had distant metastases. Immunohistochemistry indicated that all 13 primary tumors and four metastatic tumors in lymph nodes were positive for cytokeratin 19. Although none of the 13 patients showed high serum CEA levels, six patients (46.2%) had elevated serum CYFRA 21-1. Furthermore, CYFRA 21-1 was reduced in association with post-treatment tumor reduction in all six patients. Among these six patients, four developed recurrence and metastasis during the follow-up period. CYFRA 21-1 was re-elevated in all four of these patients; however, serum CEA was elevated only in the patient with distant metastasis. These results suggest that CYFRA 21-1 is more sensitive compared with CEA, and can be useful as a tumor marker for evaluating tumor progression and treatment efficacy in patients with EMPD.

http://ift.tt/2kvf4aV

Varicella zoster virus meningitis under ustekinumab because of plaque psoriasis

Abstract

Ustekinumab, a monoclonal antibody that binds to the shared p40 subunit of interleukin (IL)-12 and IL-23, is approved in the USA and Europe for moderate to severe plaque psoriasis. There are concerns that biologic treatments like ustekinumab may lead to an increased rate of infections. We report a 77-year-old woman who developed varicella zoster virus meningitis 8 weeks after initiation of ustekinumab therapy because of plaque psoriasis. She presented clinically with sudden onset of fatigue, vertigo, nausea and epileptic seizures. Investigations of the cerebrospinal fluid revealed 522/3 cells, lactate 2.9 mmol/L, protein 232 mg/dL and 2.4 × 10³ varicella zoster virus. After 3 weeks of therapy with acyclovir she recovered. We conclude that infection by varicella zoster virus has to be considered as a differential diagnosis in patients with newly developing neurological or psychiatric abnormalities under immunosuppressive therapy.

http://ift.tt/2kZ4yps

Acquired subungual fibrokeratoma

http://ift.tt/2kvdCFf

Retrospective analysis of the clinical response of palmoplantar pustulosis after dental infection control and dental metal removal

Abstract

Both metal allergy and dental focal infection have been considered as causative factors for palmoplantar pustulosis, and several case reports described that the skin lesions were ameliorated after dental metal removal or dental infection control. However, limited data are available to evaluate the association of these factors with disease severity of palmoplantar pustulosis. This study is designed to analyze the clinical outcome of 85 palmoplantar pustulosis patients after dental infection control (n = 70), tonsillectomy (n = 6) and dental metal removal (n = 9). More than half of the patients (63%, 44/70) showed positive clinical outcome after dental infection control. The skin lesions of all patients with tonsillitis were improved after tonsillectomy (100%, 6/6). On the other hand, one-third of patients (33%, 3/9) showed positive response after dental metal removal. These results suggest that focal infection is more closely associated with palmoplantar pustulosis than dental metal allergy. According to our findings, palmoplantar pustulosis patients should be preferentially examined for focal infections.

http://ift.tt/2kZ6Apd

Case of allergic contact dermatitis caused by sorbitan derivatives included in an over-the-counter topical medicament

http://ift.tt/2kv5jcD

Elevated transglutaminase-2 expression in the epidermis of psoriatic skin and its role in the skin lesion development

Abstract

Psoriasis, an inflammatory skin disease triggered by the immune system, presents keratinocyte hyperproliferation, differentiation and angiogenesis. The role of transglutaminase-2 (TG2) in psoriasis has not been fully established yet. In this retrospective, non-randomized and non-blinded study, skin biopsies were collected from 37 psoriatic patients and immunohistochemical staining was performed. TG2 staining was positive in all 37 samples, among which 32 were strong and five weak. The localization of TG2 staining was present in the epidermis and spreading from basal layer to stratum granulosum in decreasing staining intensity. However, TG2 was also expressed in the basal layer in the non-lesional site of psoriasis and the skin of healthy people. The presence of TG2 was not associated with disease duration, stage of disease and subtype of psoriasis. Overexpression of TG2 seems to be an important role in psoriatic development.

http://ift.tt/2kZ0iGf

Open-label, randomized, multicenter, phase III study to evaluate the safety and efficacy of benzoyl peroxide gel in long-term use in patients with acne vulgaris: A secondary publication

Abstract

An open-label, randomized, multicenter study was conducted to evaluate the safety and efficacy of long-term use of 2.5% and 5% benzoyl peroxide (BPO) gels administrated once daily for 52 weeks to Japanese patients with acne vulgaris. The efficacy of the study drugs was evaluated by counting inflammatory lesions and non-inflammatory lesions. Safety was evaluated based on adverse events, local skin tolerability scores and laboratory test values. In total, 458 subjects were included in the efficacy and safety analyses. The total lesion count, the efficacy end-point, was similarly changed both in the 2.5% and 5% BPO groups over the course of the study. The median rates of reduction from baseline to week 12 were approximately 65%. Thereafter, the counts were maintained at a reduced level without increasing until week 52. The median rates at week 52 were approximately 80%. Similar trends were observed for inflammatory and non-inflammatory lesion counts. Bacteriological evaluation indicated similar distribution of the minimum inhibitory concentration of each of the antibacterial drugs against Propionibacterium acnes between the values at baseline and at week 52, suggesting that long-term use did not result in changes in the drug sensitivity. The incidence of adverse events was 84.0% in the 2.5% BPO group and 87.2% in the 5% BPO group. Many of the adverse events occurred within the first month and were mild or moderate in severity and transient. The results suggest that both 2.5% and 5% BPO gels are effective and safe for long-term treatment of patients with acne vulgaris.

http://ift.tt/2kv4ksU

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Πέμπτη 2 Φεβρουαρίου 2017

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