Head and Neck Medicine by Alexandros G.Sfakianakis: 02/04/17

Σάββατο 4 Φεβρουαρίου 2017

Transcervical ultrasonographic examination of palatine tonsil size and its correlation with age, gender and body-mass index in healthy children

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Mehmet Öztürk
ObjectiveOur aim was to assess the palatine tonsil size with transcervical ultrasonography in healthy children and to analyze whether the palatine tonsil size is correlated with age, gender and body-mass index (BMI).MethodsThis series consisted of 680 healthy children (340 females, 340 males) who underwent transcervical ultrasonography for evaluation of palatine tonsil size. A total of seventeen age groups (range: 1–17 years) comprised of 40 children (20 females, 20 males) were constituted. Demographic data including gender, height, weight and BMI were noted. Correlation between baseline descriptive data and tonsil volume was investigated.ResultsThe average age was 102.51 ± 59.24 months (range: 12 to 204) and body-mass index was 17.50–5.16 kg/m2 (min: 12.4-max:25.8). The average tonsil volume was 1819.5–2023.5 mm³ (min:601, max: 4007). The tonsil volume did not differ significantly between females and males (p = 0.108). However, there was a significant difference between tonsil volumes of various age groups (p < 0.001). Tonsil size seemed to be greater in parallel with advancement of age (p < 0.001) and increased BMI (p < 0.001).ConclusionTranscervical ultrasonography can be an accurate, safe, cheap, non-invasive and accessible measure for evaluation of the size of tonsils objectively. There were strongly positive correlations between age, BMI and palatine tonsil size in healthy children and variability with respect to descriptive characteristics must be considered during diagnostic procedures and preoperative evaluation.Advances in knowledgeIn our study, we suggest that transcervical ultrasonography can be an accurate, safe, cheap, non-invasive and accessible measure for evaluation of the size of tonsils. There were positive correlations between age, BMI and palatine tonsil size in healthy children.

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Parent educational materials regarding the newborn hearing screening process

Publication date: April 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 95
Author(s): Lata A. Krishnan, Breanne Lawler, Shannon Van Hyfte
PurposeNewborn hearing screening (NHS) procedures and implementation vary from state to state in the US. The purpose of this study was to evaluate the content and nature of information provided to parents about their infant's NHS across states to answer two questions: 1) what information is included in each state's parent information brochure? and 2) do the brochures include educational information requested by parents that may help reduce parental anxiety, improve satisfaction, and decrease the potential for misunderstandings?MethodEach state's parent brochures and educational resources provided to parents were accessed via the National Center for Hearing Assessment and Management (NCHAM) website, categorized, and reviewed for content.ResultsResults indicate that the information provided to parents varies considerably across states and many brochures do not contain important information that is desired by parents.ConclusionsNHS procedures may be improved by providing standardized information regarding the process to parents in all states.

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Editorial Board

Publication date: March 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 94

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The clinical efficacy of early intervention for infected preauricular sinus

Publication date: Available online 4 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Oak-Sung Choo, Top Kim, Jeong Hun Jang, Yun-Hoon Choung
ObjectiveThe study was designed to evaluate the outcomes of early surgical intervention, and to suggest the accurate operation time and surgical strategies.MethodsA total of 190 cases (144 patients) of PAS excision were classified into 2 groups according to their time of surgery; early intervention group (n=53), and non-early intervention group (n=137). Early intervention was defined as excision performed within 3 weeks from their first hospital visit, and after acute infection control, surgical removal was followed regardless of their infection status. The mean age of patients was 18.3 ± 15.7 years old (62 male, 82 female). During surgery, a parallel incision was added when iatrogenic fistula due to incision and drainage (I &D) or additionally opened wounds caused by infection was present.ResultsCases of I & D history, revision cases, use of preoperative antibiotics were significantly higher in the early intervention group compared to the non-early intervention group, however, the time of surgery did not affect the complication rate (p = 0.533). Within the infected cases, only 1 patient from the non-early intervention group showed a minor complication of keloid scar. During our follow up period of minimum of 6 months, there was no recurrence in either groups.ConclusionThe early intervention of PASs does not seem to increase postoperative complication or recurrence rates. A double parallel skin incision is a simple but adequate technique to treat infected PASs.

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In vitro enamel erosion and abrasion-inhibiting effect of different fluoride varnishes

Publication date: May 2017
Source:Archives of Oral Biology, Volume 77
Author(s): Adílis Kalina Alexandria, Thiago Isidro Vieira, Matheus Melo Pithon, Tatiana Kelly da Silva Fidalgo, Andréa Fonseca-Gonçalves, Ana Maria Gondim Valença, Lúcio Mendes Cabral, Lucianne Cople Maia
ObjectiveTo investigate the erosion and abrasion inhibiting effect of CPP-ACP/NaF and xylitol/NaF varnishes.MethodsBovine enamel samples (n=40) were exposed to the following treatments (n=10): NaF varnish (Duraphat^®, positive control); CPP-ACP/NaF varnish (MI varnishTM); xylitol/NaF (Profluorid^®) or distilled and deionized water (MilliQ^®, negative control). The samples were submitted for 3days to 4 cycles/day of erosion (5min in Sprite Zero) and 2 cycles of abrasion/day after the first and last erosive challenge, with a toothbrush machine and slurries of a placebo toothpaste for 15s (50 strokes/s). Among the cycles and after the last daily cycle, the specimens remained in artificial saliva. The change in the enamel surface was evaluated by using 3D non-contact optical profilometry with surface roughness (Ra and Sa values) and tooth structure loss (TSL) measurements. Scanning electron microscopy (SEM) assessed the enamel topographic characteristics. Differences in the Ra, Sa and TSL among treatments were tested using one-way ANOVA followed by the Tukey test.ResultsAll varnishes promoted better results for Ra and Sa values than the negative control (p=0.0001), without difference among them (p>0.05). However, CPP-ACP/NaF varnish stimulated fewer TSL (7.09±0.70μm) compared to NaF varnish (10.33±1.36μm, p=0.002), xylitol/NaF varnish (9.96±0.41μm, p=0.007) and the negative control (18.38±3.32μm, p=0.0001).ConclusionA single-application of fluoride topical varnishes was effective in reducing enamel wear. The CPP-ACP/NaF varnish had the best effect against enamel loss from an erosion-abrasion challenge.

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Live and heat-killed Lactobacillus spp. interfere with Streptococcus mutans and Streptococcus oralis during biofilm development on titanium surface

Publication date: Available online 4 February 2017
Source:Archives of Oral Biology
Author(s): E. Ciandrini, R. Campana, W. Baffone
ObjectivesThis research investigates the ability of live and heat-killed (HK) Lactic Acid Bacteria (LAB) to interfere with Streptococcus mutans ATCC 25175 and Streptococcus oralis ATCC 9811 during biofilm formation.DesignEight Lactobacillus spp. and two oral colonizers, pathogenic Streptococcus mutans and resident Streptococcus oralis, were characterized for their aggregation abilities, cell surface properties and biofilm formation ability on titanium surface. Then, the interference activity of selected live and HK Lactobacillus spp. during S. mutans and S. oralis biofilm development were performed. The cell-free culture supernatants (CFCS) anti-biofilm activity was also determined.ResultsLAB possess good abilities of auto-aggregation (from 14.19 to 28.97%) and of co-aggregation with S. oralis. The cell-surfaces characteristics were most pronounced in S. mutans and S. oralis, while the highest affinities to xylene and chloroform were observed in Lactobacillus rhamnosus ATCC 53103 (56.37%) and Lactobacillus paracasei B21060 (43.83%). S. mutans and S. oralis developed a biofilm on titanium surface, while LAB showed a limited or no ability to create biofilm. Live and HK L. rhamnosus ATCC 53103 and L. paracasei B21060 inhibited streptococci biofilm formation by competition and displacement mechanisms with no substantial differences. The CFCSs of both LAB strains, particularly the undiluted one of L. paracasei B21060, decreased S. mutans and S. oralis biofilm formation.ConclusionsThis study evidenced the association of LAB aggregation abilities and cell-surface properties with the LAB-mediated inhibition of S. mutans and S. oralis biofilm formation. Lactobacilli showed different mechanisms of action and peculiar strain-specific characteristics, maintained also in the heat-killed LAB.

Graphical abstract

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Relationships between Oral MUC1 Expression and Salivary Hormones in Burning Mouth Syndrome

Publication date: Available online 4 February 2017
Source:Archives of Oral Biology
Author(s): Jeong-Hyun Kang, Yoon-Young Kim, Ji-Youn Chang, Hong-Seop Kho
ObjectivesTo investigate possible relationships among oral mucosal epithelial MUC1 expression, salivary female gonadal hormones and stress markers, and clinical characteristics in patients with burning mouth syndrome (BMS).DesignThirty post-menopausal female patients with BMS (60.0±5.0 years) were included. Clinical and psychological evaluations were performed and the expression level of oral mucosal epithelial MUC1 was analyzed. The levels of cortisol, dehydroepiandrosterone (DHEA), 17β-estradiol, progesterone, chromogranin A, and blood contamination were determined from unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) samples.ResultsSalivary progesterone level had significant positive correlations with oral mucosal epithelial MUC1 expression level and with salivary cortisol and DHEA levels. The salivary level of 17β-estradiol showed significant positive correlations with period of symptom duration, severity of effects of oral complaints on daily life, and results from psychological evaluations. Cortisol level in UWS and cortisol/DHEA ratio in UWS and SWS had negative correlations with severity of oral burning sensation significantly. The severity of taste disturbance had positive correlations with results from psychometry significantly.ConclusionDysregulated psychoendocrinological interactions might affect oral mucosal MUC1 expression and severity of oral burning sensation in post-menopausal BMS patients.

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In vitro enamel erosion and abrasion-inhibiting effect of different fluoride varnishes

Live and heat-killed Lactobacillus spp. interfere with Streptococcus mutans and Streptococcus oralis during biofilm development on titanium surface

Graphical abstract

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Relationships between Oral MUC1 Expression and Salivary Hormones in Burning Mouth Syndrome

Rate of Regional Nodal Metastases of Cutaneous Squamous Cell Carcinoma in the Immunosuppressed Patient

Immunosuppressed solid organ transplant recipients (SOTRs) have an increased risk of developing cutaneous squamous cell carcinomas (cSCCs) with metastatic potential. This study sought to determine the rate of regional lymph node involvement in a large cohort of solid organ transplant patients with cutaneous head and neck squamous cell carcinoma.

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The experience of treatment of coblation assisted surgical approach to Eagle’s syndrome

This article aimed to Summarize our therapeutic experience with Transoral coblation assisted surgical approach used for treatment of Eagle's syndrome.

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Melanoma of the external ear: A population-based study

Primary melanoma of the external ear (PMEE) is rare and therefore well-suited for large population-based registry analysis. The objective of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) set of cancer registries to determine the incidence, treatment, and survival characteristics of PMEE.

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International Consensus Guidelines for the Diagnosis and Management of Food Protein-Induced Enterocolitis Syndrome

Publication date: Available online 4 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): A. Nowak-Węgrzyn, M. Chehade, M. Groetch, J.M. Spergel, R.A. Wood, K. Allen, D. Atkins, S. Bahna, A. Barad, C. Berin, T. Brown Whitehorn, A.W. Burks, J.C. Caubet, A. Cianferoni, M. Conte, C. Davis, A. Fiocchi, K. Grimshaw, R. Gupta, B. Hofmeister, J.B. Hwang, Y. Katz, G.N. Konstantinou, S.A. Leonard, J. Lightdale, S. McGhee, S. Mehr, S. Miceli Sopo, G. Monti, A. Muraro, S. Noel, I. Nomura, S. Noone, H.A. Sampson, F. Schultz, S.H. Sicherer, C. Thompson, P. Turner, C. Venter, A. Westcott-Chavez, M. Greenhawt

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Genome-wide interaction study of dust mite allergen on lung function in children with asthma

Publication date: Available online 4 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Erick Forno, Joanne Sordillo, John Brehm, Wei Chen, Takis Benos, Qi Yan, Lydiana Avila, Manuel Soto-Quirós, Michelle M. Cloutier, Angel Colón-Semidey, Maria Alvarez, Edna Acosta-Pérez, Scott T. Weiss, Augusto A. Litonjua, Glorisa Canino, Juan C. Celedón
BackgroundChildhood asthma is likely the result of gene-by-environment (GxE) interactions. Dust mite is a known risk factor for asthma morbidity. Yet, there have been no genome-wide GxE studies of dust mite allergen on asthma-related phenotypes.ObjectiveTo identify genetic variants whose effects on lung function in children with asthma are modified by level of dust mite allergen exposure.MethodsA genome-wide interaction analysis of dust mite allergen level and lung function was performed in a cohort of Puerto Rican children with asthma (PRGOAL). Replication was attempted in two independent cohorts, the Childhood Asthma Management Program (CAMP) and the Genetics of Asthma in Costa Rica Study.ResultsSNP rs117902240 showed a significant interaction with dust mite allergen level on FEV1 in PRGOAL (interaction P=3.1x10^-8), and replicated in the same direction in CAMP White children and CAMP Hispanic children (combined interaction P=0.0065 for replication cohorts and 7.4 x10^-9 for all cohorts). Rs117902240 was positively associated with FEV1 in children exposed to low dust mite allergen levels, but negatively associated with FEV1 in children exposed to high levels. This SNP is on chromosome 8q24, adjacent to a binding site for CEBPβ, a transcription factor that forms part of the IL-17 signaling pathway. None of the SNPs identified for FEV1/FVC replicated in the independent cohorts.ConclusionsDust mite allergen exposure modifies the estimated effect of rs117902240 on FEV1 in children with asthma. Analysis of existing data suggests this SNP may have transcription factor regulatory functions.Capsule SummaryDust mite allergen exposure modifies the effect of certain genetic polymorphisms on lung function in children with asthma.Clinical ImplicationsThe effect of certain genetic polymorphisms on lung function in children with asthma varies depending on their dust mite allergen exposure level. Future studies should assess whether personalized interventions for these children have a greater impact on lung function.

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Mediator of DNA damage checkpoint protein 1 (MDC1) as a prognostic marker for patients with oral squamous cell carcinoma

Abstract

Background

The mediator of DNA damage checkpoint protein 1 (MDC1) is involved in the regulation of cell cycle check points and recruitment of several repair proteins to the site of DNA double stranded breaks (DSBs). The present study aims to correlate the expression of MDC1 protein with clinicopathological parameters and to evaluate its prognostic significance in patients with oral squamous cell carcinoma (OSCC).

Methods

MDC1 protein expression was evaluated immunohistochemically from untreated 100 patients with OSCC using modified H-score method. The association of MDC1 immunostaining was evaluated with clinicopathological parameters and disease outcome using univariate and multivariate survival analysis for relapse free survival (RFS) and overall survival (OS).

Results

Incidence of nuclear and cytoplasmic expression of MDC1 protein was 85% & 92%, respectively. Strong nuclear MDC1 protein expression was found to be significantly correlated with lymphnode metastasis (p=0.032). For RFS, Kaplan-Meier survival analysis demonstrated that presence of metastatic lymphnode (p=0.001), lymphatic permeation (p=0.020) and nuclear MDC1 (p=0.005) remained significant risk predictors. In multivariate survival analysis, nuclear MDC1 (p=0.027) entered at step 2 after presence of metastatic lymphnode (p=0.002) at step 1 for predicting reduced RFS. In relation to treatment, OSCC patients exhibiting weak expression of nuclear MDC1 protein were benefited significantly when treated with surgery followed by radiation therapy (p=0.001)

Conclusion

Thus, present study showed that MDC1 protein expression could be used as a prognostic marker in predicting relapse free survival in patients with OSCC. OSCC patients expressing weak MDC1 protein could be benefited by adjuvant radiotherapy instead chemo-radiotherapy.

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Reduced Chromatin acetylation of malignant salivary gland tumors correlates with enhanced proliferation

Abstract

Background

Epigenetic changes refer to any heritable modification in gene expression independent of alterations in the DNA sequence. Currently, it is well established that epigenetics represents a crucial player for tumor development. Nevertheless, the epigenetic mechanisms involved in the development and progression of salivary gland tumors (SGTs) remain poorly understood.

Methods

In the present study, we analyzed the pattern of acetyl-histone H3 (lys9) expression in benign and malignant SGTs and further correlate our results with tumors' proliferative activity and clinical outcomes. We assembled tissue microarrays (TMAs) of 84 cases of SGTs and analyzed for acetyl-histone H3 (lys9) and Ki-67 using immunohistochemistry. The study comprised 42 benign and 42 malignant SGTs.

Results

All cases included in the present study were positive to acetyl-H3 (lys9). We observed that malignant SGTs were hypoacetylated compared to benign (p=0.04). Moreover, acetyl-H3 (lys9) expression was inversely correlated with Ki67 (** p=0.02).

Conclusion

This study provides the first insight regarding histone modifications in SGTs. Our results suggest that epigenetic mechanism, particular hypoacetylation of histone H3 (lys9) might play a role in the behavior of salivary gland tumors. Also, our findings suggest that interfering with the acetylation pattern of tumor histones represents a potential novel therapeutic strategy for the treatment of SGTs.

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The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study

Publication date: Available online 4 February 2017
Source:Auris Nasus Larynx
Author(s): Soo Kweon Koo, Jong Deok Kim, Ji Seung Moon, Sung Hoon Jung, Sang Hoon Lee
ObjectiveIdentifying anatomical variations associated with pathological findings is very useful for diagnoses and therapeutics. We conducted a study to detect various anatomical variations (superior, middle, inferior turbinate concha bullosa, uncinate bulla and nasal swell body [NSB]) in connection with nasal septal deviation.MethodsThis study used a retrospective radiological design to analyze 594 (1188 sides) osteomeatal computed tomography scans from 494 male patients and 100 female patients aged between 17 and 75 years. We randomly selected 100 male and 100 female patients as controls; we compared the groups and performed a statistical analysis. All patients in the control group had sinusitis only (i.e., they lacked nasal septal deviations).ResultsLeft-sided septal deviation was found to be slightly more prevalent than right-sided deviation (43.9% and 36.4%, respectively). The incidence of S-curved septal deviation was 18.5%, that of dorso-ventral deviation was 10.9%, and that of caudal-rostral deviation was 7.6%. The incidence of only septal spur was 1.2%. In the case of middle turbinate concha bullosa, the incidence of the unilateral type was 17.3% and that of the bilateral type was 36.4%. In superior turbinate concha bullosa, the incidence of the unilateral type was 11.3% and that of the bilateral type was 27.4%. The incidence of inferior turbinate concha bullosa was 1.0% and that of uncinate bulla was 1.7%. NSB was found in 25.1% of patients, 24.7% of males and 27.0% of females. The frequencies of middle and superior concha bullosa were about 10–12 fold higher on the concave side. The nasal septal deviation group exhibited a higher incidence of most anatomical variants than the non-deviated group; differences in the middle turbinate concha bullosa attained statistical significance.ConclusionThe radiologist must focus on anatomical variants in the preoperative evaluation. It is important for surgeons to be aware of these variations.

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Unusual cause acute airway obstruction

Publication date: Available online 4 February 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): R. Vengatesh, N. Sanjeevan, Nik Fariza Husna Nik Hassan
Upper airway obstruction is one the most feared condition in Otolaryngology.Acute upper airway obstruction usually requires prompt tracheostomy as a lifesaving act. Through assessment and appropriate diagnosis and management of underlying cause are mandatory and at times even can avoid tracheostomy and its potential complications. We describe a case of severe laryngopharyngeal reflux (LPR) in 63-year-old man, causing acute stridor and airway obstruction lead to emergency tracheostomy. According to our literature review this may be the first case of LPR implicated in acute airway obstruction.

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Cephalometric evaluation after two-stage palatoplasty combined with a Hotz plate: a comparative study between the modified Furlow and Widmaier–Perko methods

The effects on craniofacial growth of two different soft palate repair techniques in two-stage palatoplasty were investigated. This was a retrospective, cross-sectional cohort study of 68 children with non-syndromic, complete unilateral cleft lip and palate. Thirty-four patients were treated with the modified Furlow method (F-group) and the remaining 34 with the Widmaier–Perko method (P-group). Craniofacial growth was assessed by analyzing 12 angular and 12 linear measurements on lateral cephalograms.

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The effect of orthognathic surgery on the temporomandibular joint and oral function: a systematic review

The objective of this systematic review was to examine the effect of orthognathic surgery (OS) on the temporomandibular joint and oral function. Electronic databases were systematically searched for studies published until October 2015. Articles were assessed against predefined inclusion criteria. The included papers were divided into four groups based on the type of OS performed. The following items were recorded: quality of evidence using the Oxford Centre for Evidence-Based medicine (CEBM) criteria, number of patients, presence/absence of controls, mean age at treatment, follow-up time, clinical examination findings, bite force, use of the Helkimo Index and Research Diagnostic Criteria for Temporomandibular Disorders, imaging findings, and patient questionnaire results.

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Does additional cone beam computed tomography decrease the risk of inferior alveolar nerve injury in high-risk cases undergoing third molar surgery?Does CBCT decrease the risk of IAN injury?

The objectives of this study were to evaluate the efficacy of additional cone beam computed tomography (CBCT) imaging on decreasing the risk of inferior alveolar nerve (IAN) injury during third molar removal in patients at high risk and to assess the surgical outcomes. The study sample included patients considered at high risk for IAN injury based on panoramic radiography (PAN) evaluation. The primary predictor was the type of imaging method (PAN only or with additional CBCT). The other variables were demographic and anatomical/radiographic factors.

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Phenytoin-induced gingival overgrowth caused by death receptor pathway malfunction

Abstract

Objective

In this study, we investigated the role of phenytoin (PHT) in death receptor-induced apoptosis of gingival fibroblasts to clarify the mechanism of PHT-induced gingival overgrowth.

Methods

Human gingival fibroblasts were cultured to semi-confluence and treated with PHT (0.025, 0.1, 0.25, and 1.0 μM) for 48 h, and then the apoptotic cell numbers were relatively determined by absorptiometry. After 24 h of 0.25 μM PHT treatment, caspase activity was measured by absorptiometry, apoptotic and cell cycle phase distribution was analyzed by flow cytometry, expression levels of apoptotic genes were quantified by real-time qPCR, and expression of apoptotic proteins was detected by western blot analysis. After 48 h of 0.25 μM PHT treatment, appearance of apoptotic cells were detected by TUNEL assay.

Results

PHT treatment decreased the proportion of apoptotic cells in gingival fibroblasts compared to a serum-free control culture in response to the protein changes as follows: PHT upregulated c-FLIP and, in turn, downregulated FADD, caspase-8, and caspase-3; PHT upregulated c-IAP2 and downregulated TRAF2; PHT downregulated caspase-9 and caspase-3 via decreased RIPK1 activity and increased Bcl-2 activity.

Conclusions

PHT-induced gingival overgrowth may result from the above-mentioned mechanisms involving apoptosis inhibition in gingival fibroblasts.

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The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study

Identifying anatomical variations associated with pathological findings is very useful for diagnoses and therapeutics. We conducted a study to detect various anatomical variations (superior, middle, inferior turbinate concha bullosa, uncinate bulla and nasal swell body [NSB]) in connection with nasal septal deviation.

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

Publication date: Available online 4 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M.J. Coyle, B. Main, D. Godden

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Comparative Columellar Scar Analysis Between W Incisions and Inverted-V Incision in Open Technique Nasal Surgery

Abstract

A visible scar on the columella is undesirable result for both patient and surgeon. So it is one of the major disadvantage of open nose surgery. Different columellar incision types have been used in open technique of nasal surgery. In this prospective study, we compare W incisions and inverted-V columellar incisions with a scar assessment scale. In this prospective randomized study, open nasal surgery (open rhinoplasty and open technique septoplasty) were performed on 93 patients between November 2009 and July 2012. The inverted-V incision was used on 31 patients (24 males, 7 females). The "W" incision was used on 62 patients (40 males, 22 females). The entire surgical procedure was performed by a single surgeon. The columellar incision was closed using 6–0 interrupted polypropylene sutures. All sutures were removed on the seventh postoperative day. Scars were assessed at 6 moths, with 3 items scar assessment scale, we observed satisfactory scar, pigmentation, and notching. We compared both groups and found that the scar pigmentation, notching and scar formation are similar to each other. As a result of this study we concluded that the inverted-V incision or "W" incision might be a similar choice in open nasal surgery.

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Migraine Related Vertigo

Abstract

Migraine related vertigo (MRV) is largely accepted in the vestibular community and probably represents the second most common cause of vertigo after benign positional vertigo by far exceeding Meniere's disease. The data on vestibular migraine management is still relatively poor, despite its enormous importance in daily practice. A 55-year old male presented with history of giddiness, imbalance, sweating and sensation of nausea with severe pulsating headache of one day duration. Ear, Nose and Throat examination was normal. Neurological tests were negative. Audiogram and Electronystagmography were within normal limits. Nystagmus was positive on turning his head to left side. By reviewing the available literature on MRV, the report aims to outline a protocol for future management. The patient and caretakers were thoroughly counseled and educated, started on Flunarizine 10 mg and Dimenhydrinate 50 mg; advice healthy life style, necessary precautions, compliance to treatment. Patient was reportedly followed up and was symptom free over a period of 9 years. There is a call for proper diagnosis to address the complaint and manage of symptoms in acute attack and prophylaxis. In addition, this case highlight the ongoing need for proper systematic evaluation, therapeutic management, follow up by ensuring compliance to medication, necessary precautions and life style modification.

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Two hemocyte sub-populations of kuruma shrimp Marsupenaeus japonicus

Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Keiichiro Koiwai, Rod Russel R. Alenton, Reina Shiomi, Reiko Nozaki, Hidehiro Kondo, Ikuo Hirono
Hemocytes in the circulating hemolymph play important roles for immune responses in shrimp. Previous studies on immune responses by hemocytes in penaeid shrimp were based on gene expression analyses of the entire population of hemocytes and thus may have missed different immune responses of different hemocyte sub-populations. In this study, we separated hemocytes into two sub-populations by Percoll gradient centrifugation, morphological characteristics of each population were then analyzed by May–Giemsa staining, flow cytometry, and FACSCalibur. Results showed hemocytes were divided into an upper layer basophilic, and lower layer of eosinophilic hemocytes. Basophilic hemocytes were larger in size compared to eosinophilic hemocytes, which were more granulated than the basophilic hemocytes. Transcriptome analysis was then conducted through RNA-seq analysis by Miseq, which revealed 16 differentially-expressed transcripts between the two sub-populations. In the upper-layer, the highly expressed transcripts that were homologous to immune-related genes that suggest hemocytes from this layer may play as the regulator of immune system and control the action of other cells to eliminate pathogen. On the other hand, transcripts that were highly expressed in the lower-layer were homologous to the antimicrobial peptide (AMP) crustin, which supports that hemocytes on this layer have granules as crustins are normally secreted from hemocyte granules. The high expression of crustin in the lower-layer also provides insight on the mechanism of the anti-microbial function, where hemocytes produce and store AMPs in its granules. These differentially expressed genes are potential hemocyte molecular markers, and among them we identified one of the highly expressed genes in the hemocytes from the upper-layer (c11736_g1) to be a promising candidate molecular marker predicted to be a surface molecule, which is a common characteristic for molecular markers.

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Regulation and functions of NLRP3 inflammasome during influenza virus infection

Publication date: Available online 4 February 2017
Source:Molecular Immunology
Author(s): Teneema Kuriakose, Thirumala-Devi Kanneganti
The NLRP3 inflammasome constitutes a major antiviral host defense mechanism during influenza virus infection. Inflammasome assembly in virus-infected cells facilitates autocatalytic processing of pro-caspase-1 and subsequent cleavage and secretion of proinflammatory cytokines IL-1β and IL-18. The NLRP3 inflammasome is critical for induction of both innate and adaptive immune responses during influenza virus infection. Inflammasome-dependent antiviral responses also regulate immunopathology and tissue repair in the infected lungs. The regulation of NLRP3 inflammasome assembly is an area of active research and recent studies have unraveled multiple cellular and viral factors involved in inflammasome assembly. Emerging studies have also identified the cross talk between inflammasome activation and programmed cell death pathways in influenza virus-infected cells. Here, we review the current literature regarding regulation and functions of NLRP3 inflammasome during influenza virus infection.

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Comparative Columellar Scar Analysis Between W Incisions and Inverted-V Incision in Open Technique Nasal Surgery

Abstract

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Migraine Related Vertigo

Abstract

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Lipoprotein(a)-hyperlipoproteinemia as cause of chronic spinal cord ischemia resulting in progressive myelopathy – successful treatment with lipoprotein apheresis

Abstract

High concentrations of lipoprotein(a) (Lp(a)) represent an important independent and causal risk factor associated with adverse outcome in atherosclerotic cardiovascular disease (CVD). Effective Lp(a) lowering drug treatment is not available. Lipoprotein apheresis (LA) has been proven to prevent cardiovascular events in patients with Lp(a)-hyperlipoproteinemia (Lp(a)-HLP) and progressive CVD. Here we present the course of a male patient with established peripheral arterial occlusive disease (PAOD) at the early age of 41 and coronary artery disease (CAD), who during follow-up developed over 2 years a progressive syndrome of cerebellar and spinal cord deficits against the background of multifactorial cardiovascular risk including positive family history of CVD. Spastic tetraplegia and dependency on wheel chair and nursing care represented the nadir of neurological deficits. All conventional risk factors including LDL-cholesterol had already been treated and after exclusion of other causes, genetically determined Lp(a)-HLP was considered as the major underlying etiologic factor of ischemic vascular disease in this patient including spinal cord ischemia with vascular myelopathy. Treatment with an intensive regimen of chronic LA over 4.5 years now was successful to stabilize PAOD and CAD and led to very impressive neurologic and overall physical rehabilitation and improvement of quality of life.

Measurement of Lp(a) concentration must be recommended to assess individual cardiovascular risk. Extracorporeal clearance of Lp(a) by LA should be considered as treatment option for select patients with progressive Lp(a)-associated ischemic syndromes.

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Fluids and sepsis: changing the paradigm of fluid therapy: a case report

Over the past 16 years, sepsis management has been guided by large-volume fluid administration to achieve certain hemodynamic optimization as advocated in the Rivers protocol. However, the safety of such pract...

http://ift.tt/2kEuedJ

Treatment for residual stones using flexible ureteroscopy and holmium laser lithotripsy after the management of complex calculi with single-tract percutaneous nephrolithotomy

Abstract

This study validated the effectiveness and safety of the treatment for residual stones using flexible ureteroscopy (fURS) and holmium laser (0.6–1.2 J, 20–30 Hz) lithotripsy via a fiber with a 200-μm core diameter and 0.22 numerical aperture (NA) after the management of complex calculi with single-tract percutaneous nephrolithotomy (PCNL). Between January 2014 and June 2016, 27 consecutive patients with complex calculi underwent fURS and holmium laser lithotripsy after a planned single-tract PCNL. Among the 27 patients with complex calculi, 9 had full staghorn calculi, 7 had partial staghorn calculi, and 11 had multiple calculi. After the first single-tract PCNL session, the mean stone size and mean stone surface area were 18.0 ± 10.7 mm and 181.9 ± 172.2 mm², respectively. Treatment for residual stones with fURS and holmium laser lithotripsy was successfully completed and was performed without intraoperative complications. The mean operative time of the fURS procedure was 69.1 ± 23.6 min, and the mean hospital stay was 5.3 ± 2.4 days. The mean decrease in the hemoglobin level was 7.3 ± 6.5 g/l. After the fURS procedure, the overall stone-free rate was 88.9%. The overall postoperative complication rate was 14.8% (Clavien grade I 11.1%; Clavien grade II 3.7%). The current approach tested here combines the advantages of both PCNL and fURS and effectively manages complex calculi with a high stone-free rate (SFR) (88.9%). This approach also reduced the number of treatment sessions, the number of percutaneous access tracts, and the blood loss and potential morbidity associated with multiple tracts.

http://ift.tt/2l8NLjD

Transfacial and Craniofacial Approaches for Resection of Sinonasal and Ventral Skull Base Malignancies

Malignancies of the paranasal sinuses and ventral skull base present unique challenges to physicians. A transfacial or craniofacial approach allows for wide, possibly en bloc resection and is ideal for tumors that involve surrounding soft tissue, the palate, the orbit, anterolateral frontal sinus, and lateral dura. Transfacial approaches include a lateral rhinotomy often combined with a medial, subtotal, or total maxillectomy. Reconstruction is most commonly performed with a pericranial flap to separate the intranasal and intracranial compartments. These approaches have evolved and been refined but now are usually reserved for advanced tumors not amenable to endoscopic resection.

http://ift.tt/2jKOjAd

Endoscopic Resection of Sinonasal and Ventral Skull Base Malignancies

The transnasal endoscopic resection of ventral skull base lesions represents a safe and effective method for the surgical management of sinonasal and ventral skull base malignancies in carefully selected cases. The goal of surgery is complete removal of all tumor with negative resection margins while maintaining the key oncological principles. Careful selection of cases along with the presence of an experienced surgeon and a fully involved multidisciplinary skull base team trained in the management of ventral skull base neoplasm are essential for excellent outcomes.

http://ift.tt/2k78m80

Endoscopic Resection of Pterygopalatine Fossa and Infratemporal Fossa Malignancies

The endoscopic resection of pterygopalatine and infratemporal fossa malignancies allows excellent visualization and manipulation of tissues in an anatomically complex area compared with open approaches. With less approach morbidity, endoscopic endonasal surgery allows an easier recovery and earlier transition to adjuvant radiotherapy. The endoscopic approach is minimal access but rarely minimally invasive. Surgeons should not hesitate to gain wide surgical exposure of the pterygopalatine, infratemporal fossa, and petrocavernous carotid artery to ensure comfortable maneuverability and easy visualization of the tumor and its normal tissue margins. This method maximizes the chances of complete resection and effective postoperative surveillance.

http://ift.tt/2k72w6g

Lupus nephritis and pregnancy outcome

Publication date: Available online 3 February 2017
Source:Autoimmunity Reviews
Author(s): Karen Schreiber, Ksenija Stach, Savino Sciascia

http://ift.tt/2kEiurJ

Non-receptor type, proline-rich protein tyrosine kinase 2 (Pyk2) is a possible therapeutic target for Kawasaki disease

Publication date: Available online 3 February 2017
Source:Clinical Immunology
Author(s): Chinatsu Suzuki, Akihiro Nakamura, Noriko Miura, Kunityoshi Fukai, Naohito Ohno, Tomoyo Yahata, Akiko Okamoto-Hamaoka, Maiko Fujii, Ayako Yoshioka, Yuki Kuchitsu, Kazuyuki Ikeda, Kenji Hamaoka
Kawasaki disease (KD) is a paediatric vasculitis whose pathogenesis remains unclear. Based on experimental studies using a mouse model for KD, we report here that proline-rich protein tyrosine kinase 2 (Pyk2) plays a critical role in the onset of KD-like murine vasculitis.The mouse model for KD was prepared by administrating a Candida albicans water-soluble fraction (CAWS). Unlike CAWS-treated WT mice, CAWS-treated Pyk2-Knockout (Pyk2-KO) mice did not develop apparent vasculitis. A sustained increase in MIG/CXCL9 and IP-10/CXCL10, both of which have potent "angiostatic" activity, was observed in CAWS-treated Pyk2-KO mice. CAWS-induced activation of STAT3, which negatively regulates the expression of these chemokines, was also attenuated in macrophages derived from Pyk2-KO mice.The present study suggests that defects in Pyk2 suppress KD-like experimental vasculitis, presumably through CXCL9- and CXCL10-dependent interference with neo-angiogenesis. Since Pyk2-KO mice show no life-threatening phenotype, Pyk2 may be a promising therapeutic target for KD.(147/150 words)

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Palatal Injection For The Removal of Maxillary Teeth: Current Practice Amongst Oral and Maxillofacial Surgeons

Publication date: Available online 4 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): E.K. Badenoch-Jones, M. David, T. Lincoln
PurposeConventional teaching regarding palatal injection for the removal of maxillary teeth dictates that both a buccal and palatal injection are to be administered. Recently, some authors have questioned the necessity of the palatal injection, suggesting that contemporary local anaesthetics might diffuse sufficiently across the buccal-palatal cortical bone distance. It has been suggested that since the buccal-palatal cortical bone distance increases anteriorly to posteriorly in the maxilla, the success of maxillary extractions with buccal injection only, might be related to anterior-posterior position of the tooth.Evidence from clinical trials has only relatively recently become available. Since 2006, fifteen clinical trials that examined outcomes of maxillary tooth extractions performed with buccal injection of local anaesthetic only, have been published. However, there is limited data available regarding the clinical practice of surgeons.Patients and MethodsAn online survey was sent to 276 full members of the Canadian Association of Oral and Maxillofacial Surgeons. Respondents were asked about their use of palatal injection for the removal of maxillary teeth under local anaesthesia, including how often they administer a palatal injection for maxillary extractions in each region of the maxilla.Results92 responses were received (33%). Most practitioners deliver a palatal injection for every maxillary tooth extraction under local anaesthetic. However, there is a significant number who do not always administer a palatal injection (i.e. they give it 'most of the time', 'occasionally' or 'never'). This number decreased in a linear fashion anteriorly to posteriorly in the maxilla: incisors: 17/89; canines: 16/88; premolars: 13/88; first and second molars: 10/89; third molars: 10/88.ConclusionThere are a number of surgeons who do not always administer a palatal injection for extraction of maxillary teeth under local anaesthetics. The number is greater for anterior compared to posterior teeth.

http://ift.tt/2kd8wwX

Potential for Osseous Regeneration of Platelet Rich Fibrin - A Comparative Study In Mandibular Third Molar Impaction Sockets

Publication date: Available online 4 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mathew P. Varghese, Suvy Manuel, L.K. Surej Kumar
PurposeOur study determined the potential for osseous regeneration of platelet rich fibrin (PRF) in mandibular third molar impaction sockets along with its soft tissue healing potential.Patients and MethodsWe designed the study to be carried out as a prospective in-vivo study. Following extraction, randomization was done. On one side, the socket was sutured primarily (control site) and on the other, autologous PRF gel, was placed and sutured (test site/PRF site). Post operatively, grid periapical radiographs were obtained, at periodic intervals (1st week, 4th week, 16th week) and digitalized. The grey level values were measured at 3 different regions of the socket (RNFB – Regions of Newly Formed Bone), compared with natural bone area (NBA); using HL Image++ software, and calculation of percentage bone fill was made. Clinical evaluation of soft tissue healing was done using Landry Turnbull & Howley index at the specific intervals.Results30 healthy subjects, both male & female (age 18 – 35 years) with bilaterally impacted mandibular third molars were enrolled in this study. It was found that, in general, there was significantly greater bone formation in sockets treated with PRF (P value < 0.05). In the PRF group, the average grey level values at cervical, middle and apical regions were 61.85 (SD ± 25.186), 64.54 (SD ± 24.831) & 67.80 (SD ± 23.946), respectively, with a mean value of 64.73 (SD ± 24.411). In the control group, these values were 51.58 (SD ± 15.286), 54.30 (SD ± 16.274) &57.53 (SD ±16.187) respectively with a mean of 53.67 (SD ± 16.528). The average percentage bone fill of PRF category patients was 57.90 (SD ± 26.789) and that of the non PRF patients, 46.74 (SD ± 17.713) (P<0.05). The soft tissue healing as evaluated by Landry Turnbull & Howley healing index also was found to be better on the (PRF) test site and it was statistically significant (P<0.05).ConclusionsThere was evidence for better osseous regeneration & soft tissue healing occurring in response to PRF. Further investigations to evaluate the application of PRF in other areas of oral and maxillofacial surgery is imperative.

http://ift.tt/2ksMEfy

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

In their recent paper, Rogers et al. have given a valuable insight into patients' thoughts about temporary tracheostomy after microvascular reconstruction for cancer of the head and neck.1 They report that the key general observation was fear, specifically a fear of choking. A total of 47% of patients in the study had their tracheostomy in situ for more than 7days and 60% said they would very much prefer to avoid a tracheostomy if possible. The authors concluded that not all patients who have free-flap reconstruction will require tracheostomy.

http://ift.tt/2l8Uie5

Allergic Asthma: An Overview of Metabolomic Strategies leading to the Identification of Biomarkers in the Field

Abstract

Allergic asthma is a prominent disease especially during childhood. Indoor allergens, in general, and particularly house dust mites (HDM) are the most prevalent sensitizers associated with allergic asthma. Available data shows that 65 to 130 million people are mite-sensitized worldwide and as many as 50% of these are asthmatic. In fact, sensitization to HDM in the first years of life can produce devastating effects on pulmonary function leading to asthmatic syndromes that can be fatal. To date, there has been considerable research into the pathological pathways and structural changes associated with allergic asthma. However, limitations related to the disease heterogeneity and a lack of knowledge into its pathophysiology have impeded the generation of valuable data needed to appropriately phenotype patients and, subsequently, treat this disease. Here, we report a systematic and integral analysis of the disease, from airway remodeling to the immune response taking place throughout the disease stages. We present an overview of metabolomics, the management of complex multifactorial diseases through the analysis of all possible metabolites in a biological sample, obtaining a global interpretation of biological systems. Special interest is placed on the challenges to obtain biological samples and the methodological aspects to acquire relevant information, focusing on the identification of novel biomarkers associated with specific phenotypes of allergic asthma. We, also, present an overview of the metabolites cited in the literature, which have been related to inflammation and immune response in asthma and other allergy-related diseases.

http://ift.tt/2l4c5Y7

The clinical and immunological effects of Pru p 3 SLIT on peach and peanut allergy in patients with systemic reactions

Abstract

Background

The peach non-specific lipid transfer protein (nsLTP), Pru p 3, is the primary sensitizer in fruits and responsible for severe reactions in the Mediterranean area. Peach allergy is frequently associated with other allergies such as peanut. Therefore, it is important to assess how specific immunotherapy to Pru p 3 could affect both peach and peanut tolerance.

Objectives

To evaluate peach and peanut desensitization and immunological changes after one year of Pru p 3 sublingual immunotherapy (SLIT) in patients with systemic allergic reactions to peach and/or peanut.

Methods

Forty-eight peach allergic patients, 36 treated with SLIT and 12 non-treated, were monitored for 12 months. Treated patients were sub-classified as peanut allergic (Group A), sensitized (Group B) or tolerant (Group C). SLIT effect was evaluated by skin prick test (SPT) reactivity and food challenge. Immunological changes were evaluated by monitoring sIgE and sIgG4 levels and basophil reactivity.

Results

After one year of SLIT, the wheal area in SPT significantly decreased and a significant increase in peach threshold in treated patients was observed(p<0.001). Patients in Group A showed a significant decrease in peanut SPT wheal area and an increase in peanut threshold (p<0.001). Immunological changes were observed in treated patients only, with a significant decrease of sIgE and a parallel increase of sIgG4, sIgG4/sIgE and basophil reactivity for both Pru p 3 and Ara h 9.

Conclusion

After one year, Pru p 3 SLIT induces both desensitization and immunological changes not only for peach but also for other food allergens relevant in the induction of severe reactions such as peanut.

http://ift.tt/2l80WCk

Janus kinase inhibitors in dermatology: A systematic review

Janus kinase (JAK) inhibitors are emerging as a promising new treatment modality for many inflammatory conditions.

http://ift.tt/2jL6EwU

Correction

Paller AS, Tom WL, Lebwohl MG, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016;75:494-503.

http://ift.tt/2ksIoge

Histopathological and scanning electron microscopy findings of retrieved porous polyethylene implants

Porous polyethylene (PPE) implants are biocompatible alloplastic materials commonly used for facial augmentation. However, the effect of sub-periosteal PPE application on the surrounding tissues has not been analyzed clearly. This report documents the case of a 22-year-old woman who underwent peri-alar augmentation with PPE to improve midface retrusion. Although no infection or inflammation occurred at the surgical site, the patient requested removal of the PPE implant for aesthetic reasons alone at 1 year after the surgery.

http://ift.tt/2kDB8A0

Head and neck lymphomas: A 20-year review in an Oral Pathology Unit, Johannesburg, South Africa, a country with the highest global incidence of HIV/AIDS

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Nasreen Alli, Shabnum Meer
ObjectivesNon-Hodgkin lymphoma occurs with increasing frequency in HIV/AIDS. As South Africa has the highest incidence of HIV/AIDS worldwide, an epidemiologic study of this nature provides insight into head and neck lymphomas in a defined South African population. This retrospective review evaluated frequency and clinico-pathologic characteristics of patients diagnosed with head and neck lymphoma at the Oral Pathology Department, University of Witwatersrand between 1993 and 2012.Materials and methodsHistopathology reports of patients with head and neck lymphomas (n=504) were reviewed. Demographic (age, gender), clinical (site and size of tumour), laboratory and histological parameters were recorded.ResultsThere were 504 patients with head and neck lymphomas. The mean age was 40.4years. The male:female ratio was 1.1:1. The cervical lymph node was the most common anatomic site (115 cases) and the maxilla (60 cases) the most common extranodal site. Plasmablastic lymphoma (159 cases) was the most common histologic subtype, seen more frequently as a result of its strong association with HIV/AIDS. The most common Hodgkin's lymphoma was the nodular sclerosing variant (21 cases). Of the head and neck lymphomas in patients with a known HIV status, 56% had plasmablastic lymphoma, 43.9% diffuse large B cell lymphoma and 25% Burkitt lymphoma.ConclusionThere is an increase in head and neck lymphoma frequency, contrary to that found in Western countries. The high HIV prevalence in certain lymphomas provides strong indication of the role of HIV/AIDS in pathogenesis of lymphomas. This study serves as a baseline for future studies, especially in South Africa.

http://ift.tt/2l3NP8y

High-dose versus weekly cisplatin definitive chemoradiotherapy for HPV-related oropharyngeal squamous cell carcinoma of the head and neck

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Cesar Augusto Perez, Xiaoyong Wu, Mark J. Amsbaugh, Rahul Gosain, Wederson M. Claudino, Mehran Yusuf, Teresa Roberts, Dharamvir Jain, Alfred Jenson, Sujita Khanal, Craig I. Silverman, Paul Tennant, Jeffrey M. Bumpous, Neal E. Dunlap, Shesh N. Rai, Rebecca A. Redman
ObjectivesTo compare the outcomes and toxicity of high-dose cisplatin (HDC) versus weekly cisplatin (WC) definitive chemoradiotherapy (CRT) for patients with human papillomavirus (HPV) related oropharyngeal squamous cell carcinoma (SCCOPx).MethodsAll patients with p16 positive SCCOPx treated with definitive CRT with cisplatin between 2010 and 2014 at a single institution were retrospectively reviewed. CTCAE v 4.03 toxicity criteria were used. The Kaplan-Meier method was used to estimate event-free survival (EFS) and the overall survival (OS).ResultsOf the 55 patients included, 22 were patients treated with HDC at dose of 100mg/m² on days 1 and 22; and the remaining 33 patients were treated with WC at 40mg/m². Both cohorts received a median total dose of cisplatin of 200mg/m². At median follow-up of 31months, there was one local failure and no distant failures in the HDC cohort. In the WC group, there were 6 total failures (2 local, 4 distant). Estimated 2-year EFS was better in HDC cohort as compared to WC (96% vs. 75%; p=0.04). There was no significant difference in 2-year OS (95% vs. 94%; p=0.40). Weight loss, gastric tube dependence at six months, acute renal injury and grade 3 or 4 hematological toxicity were all similar between both groups.ConclusionsHPV-related SCCOPx treated with definitive CRT with either HDC or WC had similar toxicity profile. HDC had better EFS when compared with WC and this seems to be driven by increased distant failure rates, although the OS was similar.

http://ift.tt/2l7ItWq

Oropharyngeal cancer prognosis by tumour HPV status in France: The multicentric Papillophar study

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Jean Lacau St Guily, Alexandra Rousseau, Bertrand Baujat, Sophie Périé, Philippe Schultz, Béatrix Barry, Xavier Dufour, Olivier Malard, Jean-Luc Pretet, Christine Clavel, Philippe Birembaut, Silvia Franceschi
AimsTo evaluate the impact of human papillomavirus (HPV) status, tobacco smoking and initial treatment approach on progression-free survival (PFS) and overall survival (OS) for oropharyngeal cancer (OPC) in France, a country where smoking declines started late (1990s).Methods340 OPC patients (median age: 60years) from 14 French hospitals were followed up (median 26.7months). PCR-based positivity for both HPV DNA and E6/E7 mRNA was used to distinguish HPV-positive OPC (27.1%). Hospital-stratified hazard ratios (HR) and corresponding 95% confidence intervals (CI) were used to compare PFS and OS according to HPV and other prognostic factors in hospital-stratified unadjusted and multivariate models. The combined effect of HPV status with either smoking, stage, or initial treatment on PFS was also evaluated.ResultsPFS in multivariate analysis was better in HPV-positive patients (HR=0.42; 95% CI: 0.24–0.73) and worse in older patients (HR for 5-year age increase=1.12) and those having had firstly radiotherapy (HR=1.86; 95% CI: 1.19–2.92) or induction chemotherapy (HR=1.73; 95% CI: 1.08–2.79) instead of upfront surgery. Findings for OS were similar. Loco-regional recurrences were less frequent in HPV-positive (10.5%) than HPV-negative patients (26.0%) but distant recurrences were similarly frequent. HPV status did not modify the influence of smoking or stage on PFS but the impossibility to perform upfront surgery may be more relevant for HPV-negative patients.ConclusionsHPV-positive OPC patients fare better than HPV-negative OPC and may benefit from toxicity-sparing. Whether HPV-negative patients responded less well to radiation and chemotherapy because of more severe genomic damage or bulkier tumours is unclear.

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EACMFS Prizes and Awards

Publication date: February 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 2

http://ift.tt/2jNTCdj

Editorial Board

Publication date: February 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 2

http://ift.tt/2l3C5CC

Odontogenic sinusitis maxillaris: A retrospective study of 121 cases with surgical intervention

Publication date: Available online 4 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Matthias Zirk, Timo Dreiseidler, Matthias Pohl, Daniel Rothamel, Johannes Buller, Franziska Peters, Joachim E. Zöller, Matthias Kreppel
Odontogenic maxillary sinusitis - retrospective study of 121 cases with surgical intervention.PurposeOtolaryngologists, dentists and maxilla-facial surgeons see patients suffering from odontogenic maxillary sinusitis on a daily routine. The study was performed to investigate the different origins of the odontogenic maxillary sinusitis ranging from periodontitis to augmentative implant surgery. Furthermore, the microbial flora of purulent odontogenic maxillary sinusitis was analyzed in order to present a proper antibiotic treatment in addition to a surgical approach.Materials and MethodsA retrospective study was performed, analyzing the clinical trials of 121 patients suffering from odontogenic maxillary sinusitis who undergone surgery. Harvested bacteria were tested for susceptibility on a routine base, surgical reports of removed foreign material or dental focus were reviewed as well as preoperative CBCT.ResultsPatients mean age was 56.62 (±16 SD) with a slight female gender dominance. Allergic profile to ß-lactam antibiotics had no influence on patients' length of in-hospital stay. 69 out of 121 cases of OMS occurred after dental surgery (extractions, augmentation or implant surgery). Maxillary molars were the teeth mostly hold accountable for an onset without surgery in recent history. 22.3 % of the patients possessed a dislocated foreign body in the maxillary sinus. Pseudomonas aeruginosa infection was significantly associated with misplaced foreign bodies (root filling, augmentative dental material e.g.; p<0.05). We protocolled an anaerobic dominance with 45 anaerobes versus 19 aerobes. Ampicillin/Sulbactam (80%) and Piperacillin/Tazobactam (93.3%) present sufficient susceptibly rates to the harvested bacteria. Likewise showed Moxifloxacin (86.3%) equal results, whereas Clindamycin had a poor outcome with merely 50 % of the tested bacteria being susceptible to Clindamycin.ConclusionIf OMS is diagnosed dental focus should be treated, misplaced bodies should be removed and purulent exacerbation has to be additionally treated with a calculated antibiotic therapy according to the pathogens resistance patterns.

http://ift.tt/2jNPYzV

Announcements

Publication date: February 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 2

http://ift.tt/2l3tlfO

H1-antihistamine-refractory chronic spontaneous urticaria: It's worse than we thought – first results of the multicenter real-life AWARE study

Abstract

Background

Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centers. Little is known about CSU patient characteristics and the burden of CSU in routine clinical practice. AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real-life setting.

Objective

To describe the baseline characteristics of the first 1,539 German AWARE patients with H1-antihistamine-refractory CSU.

Methods

This prospective non-interventional study included patients (18 to 75 years) with a diagnosis of H1-antihistamine-refractory CSU for >2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU-Q₂oL), and angioedema QoL questionnaire (AE-QoL; in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively.

Results

Between March and December 2014, 1,539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index was 70%, 46.3 years, and 27 kg/m², respectively. The mean UCT score was 7.9, 1 in 2 patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU; 24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second generation H1-antihistamines (46.3%), first generation H1-antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU-Q₂oL, and total AE-QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%).

Conclusion & Clinical Relevance

This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.

http://ift.tt/2kceoGG

Conjunctival provocation test in diagnosis of peanut allergy in children

Abstract

Background

Peanut allergy frequently cause severe allergic reactions. Diagnosis include detection of IgE to peanuts in serum or by skin prick tests. While children may have allergic sensitisation without having clinical peanut allergy, oral peanut challenge is often required for accurate diagnosis. The conjunctival provocation test is used for diagnosis and evaluation of treatment effect in inhalant allergies, but it has not been evaluated as a tool for diagnosing peanut allergy.

Objective

To investigate if the conjunctival provocation tests may be feasible, accurate and safe in diagnosing clinically relevant peanut allergy in patients with suspected peanut allergy.

Methods

This cross-sectional case-control study in children with clinical or laboratory suspected peanut allergy included 102 children recruited from the regional paediatric departments and specialist practices during one year from April 2011. A peanut tolerant control group of 28 children of similar age was recruited locally. A double-blind placebo-controlled conjunctival provocation test with peanut extract was performed in all children, while oral peanut provocation was performed as double-blind placebo-controlled challenge in children with suspected peanut allergy and as an open challenge in the control children.

Results

All 81 children with a positive double-blind placebo-controlled oral food challenge also had a positive conjunctival provocation test. None of the children with negative conjunctival provocation test had a positive oral food challenge. The sensitivity and the specificity of the conjunctival provocation test was 0.96 and 0.83 respectively. No children had severe adverse reaction caused by the conjunctival provocation test, whereas 23 children suffered an anaphylactic reaction to the oral food challenge.

Conclusion & Clinical Relevance

Conjunctival allergen challenge appears to be a feasible, accurate and safe in diagnosing children referred for suspected peanut allergy.

http://ift.tt/2ks2abA

Migrant status and childhood hospitalizations for asthma and other wheezing disorders

Abstract

Background

In developed Western settings, asthma is more prevalent among second-generation compared to first-generation migrants. However, these studies are difficult to interpret as they include migrants of various ethnicities and countries of origin.

Objective

We assessed the association of parental migrant status with wheezing disorders among children born in Hong Kong, a developed non-Western setting, where many children have migrant parents from mainland China of the same ethnicity.

Methods

We used Cox regression to examine the adjusted associations of parental migrant status with time to first public hospital admission for asthma, bronchitis and bronchiolitis (International Classification of Diseases, Ninth Version Clinical Modification 466, 490 and 493) from 9 days to 12 years in a population-representative birth cohort of 8327 Chinese children in Hong Kong.

Results

Having both parents as migrants was associated with higher risk of hospitalization for asthma and other wheezing disorders, compared to both parents being Hong Kong born (hazard ratio 1.30, 95% confidence interval 1.05 to 1.60 from 9 days to 6 years), adjusted for type of hospital at birth, parental history of allergies, mother's age at birth, father's age at birth, and highest parental education.

Conclusions and Clinical Relevance

In the unique, non-Western context of Hong Kong, second-generation migrants had higher risk of hospitalization for childhood wheezing disorders compared to the native population, particularly before 6 years of age. Further study is required to clarify the underlying mechanisms involved.

http://ift.tt/2kcf3b2

Vitamin D regulates immunoglobulin mucin domain molecule-4 expression in dendritic cells

Abstract

Background and aims

Dendritic cell (DC)-derived immunoglobulin domain molecule (TIM)4 plays a critical role in the initiation of T helper (Th)2 polarization. Vitamin D (VitD) involves the regulation of a number of immune responses. This study tests a hypothesis that VitD regulates TIM4 expression in DCs.

Methods

Peripheral blood samples were collected from patients with allergic rhinitis (AR) and healthy subjects. DCs were isolated from the samples and analyzed for the expression of TIM4.

Results

We observed that the levels of calcitriol, the active form of VitD3, in the sera of AR patients were lower than that in healthy subjects. The peripheral DC expressed higher levels of TIM4 and lower levels of VDR. A negative correlation was identified between the data of serum calcitriol and TIM4 in DCs. Exposure DCs to calcitriol in the culture increased the expression of VDR. We also found that VDR bound to the TIM4 promoter locus in DCs to repress the TIM4 gene transcription and expression.

Conclusions

VitD deficiency may contribute to the pathogenesis of AR by increasing the TIM4 expression. The results suggest that to regulate the serum calcitriol levels and the expression of VDR in DCs may be necessary to be taken into account in the treatment of AR.

http://ift.tt/2krTXEk

Regulatory T Cells and Type 2 Innate Lymphoid Cell Dependent Asthma

Abstract

Group two innate lymphoid cells (ILC2s) are a recently identified group of cells with the potent capability to produce Th2-type cytokines such as interleukin (IL)-5 and IL-13. Several studies suggest that ILC2s play an important role in the development of allergic diseases and asthma. Activation of pulmonary ILC2s in murine models lacking T and B cells induces eosinophilia and airway hyperreactivity (AHR), which are cardinal features of asthma. More importantly, numerous recent studies have highlighted the role of ILC2s in asthma persistence and exacerbation among human subjects and thus, regulation of pulmonary ILC2s is a major area of investigation aimed at curbing allergic lung inflammation and exacerbation. Emerging evidence reveals that a group of regulatory T cells, induced Tregs (iTregs), effectively suppress the production of ILC2-driven, pro-inflammatory cytokines IL-5 and IL-13. The inhibitory effects of iTregs are blocked by preventing direct cellular contact or by inhibiting the ICOS-ICOS-ligand (ICOSL) pathway, suggesting that both direct contact and ICOS-ICOSL interaction are important in the regulation of ILC2 function. Also, cytokines such as IL-10 and TGF-β1 significantly reduce cytokine secretion by ILC2s. Altogether, these new findings uncover iTregs as potent regulators of ILC2 activation and implicate their utility as a therapeutic approach for the treatment of ILC2-mediated allergic asthma and respiratory disease.

http://ift.tt/2kDeIis

The first comparative study of the perioperative outcomes between pure laparoscopic donor hepatectomy and laparoscopy-assisted donor hepatectomy in a single institution.

Background: In a statement from the second International Consensus Conference for Laparoscopic Liver Resection, adult-to-adult laparoscopic donor surgery was the earliest phase of development. It was recommended that the procedure be performed under institutional ethical approval and a reporting registry. Method: At our institute, we started laparoscopy-assisted donor hepatectomy (LADH) in 2007 and changed to pure laparoscopic donor hepatectomy (PLDH) in 2012. This study included 40 living donors who underwent LADH and 14 live donors who underwent PLDH. We describe the technical aspects and outcomes of our donor hepatectomy from assist to pure and examine the liver allograft outcomes of the recipients after LADH and PLDH. Results: There was significantly less blood loss in the PLDH group (81.07 +/- 52.78 g) than in the LADH group (238.50 +/- 177.05 g), although the operative time was significantly longer in the PLDH group (454.93 +/- 85.60 min) than in the LADH group (380.40 +/- 44.08 min). And there were no significant differences in postoperative complication rate in the 2 groups. The liver allograft outcomes were acceptable and comparable with open living donor hepatectomy. Conclusion: By changing our routine approach from assist to pure, PLDH can be performed safely, with better exposure due to magnification, and with less blood loss under pneumoperitoneal pressure. PLDH, which has become our promising donor procedure, results in less blood loss, better cosmesis, and the donor's complete rehabilitation without deterioration in donor safety. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Severe transplantation-mediated alloimmune thrombocytopenia in 2 recipients of organs from the same donor.

No abstract available

http://ift.tt/2krXiTP

AN INVESTIGATION OF EXTRACELLULAR HISTONES IN PIG-TO-BABOON ORGAN XENOTRANSPLANTATION.

Background: Serum (extracellular) histone levels are increased in inflammatory states and in the presence of coagulation dysfunction, eg, trauma, chemical/ischemic injury, infection. There is increasing evidence of a systemic inflammatory response associated with the presence of a pig xenograft in a nonhuman primate. We evaluated extracellular histone levels in baboons with various pig xenografts. Methods: We measured serum histones in baboons with pig heterotopic heart (n=8), life-supporting kidney (n=5), orthotopic liver (n=4), and artery patch (n=9) grafts by ELISA. C-reactive protein (CRP), free triiodothyronine (fT3), serum amyloid A (SAA), and platelet counts were also measured, all of which may provide an indication of an inflammatory state. We investigated the effect of histones on platelet aggregation and on cytotoxicity of pig cells in vitro. Results: Serum histones increased when baboons developed consumptive coagulopathy (CC) (eg, thrombocytopenia) or infection. CRP levels tended to be higher and fT3 levels lower when CC developed. Measurement of SAA correlated fairly well with CRP and indicated the state of inflammation. Treatment of the recipient with tocilizumab reduced the level of serum histones, CRP, and SAA, and increased the level of fT3 and platelet counts. In vitro, histone-induced platelet aggregation and endothelial cell apoptosis were both significantly reduced by the NF-kB pathway inhibitor, parthenolide. Conclusions: These noninvasive assays may be useful for monitoring the health status of nonhuman primate recipients of pig organ grafts and may help in management after xenotransplantation. Tocilizumab and NF-[kappa]B inhibitors might prove valuable in reducing the inflammatory response to a pig xenograft. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kclUBx

Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics.

Background and Objectives: This study aimed to describe in detail the relevant sonoanatomy, technique, and block dynamics of an ultrasound-guided costoclavicular brachial plexus block (BPB). Methods: Thirty patients scheduled for hand or forearm surgery under a BPB underwent transverse ultrasound imaging of the medial infraclavicular fossa to identify the cords of the brachial plexus at the costoclavicular space (CCS). An ultrasound-guided BPB was then performed at the CCS with 20 mL of 0.5% ropivacaine. Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves were assessed at regular intervals for 30 minutes after the injection. Successful block was defined as being able to complete surgery under the BPB. Results: The CCS was visualized as a well-defined intermuscular space lying deep and posterior to the mid-point of the clavicle. The cords of the brachial plexus were clustered together lateral to the axillary artery within the CCS. The costoclavicular BPB was successfully performed in all patients, and the median onset time for sensory and motor blockade of all the 4 nerves was 5 [5-15] and 5 [5-10] minutes, respectively. Complete sensory blockade of all the 4 nerves was achieved in 30 [20-30] minutes, and the BPB was successful in 29 (97%) of 30 patients. There were no complications directly related to the technique or the local anesthetic injection. Conclusions: This report describes a novel technique of infraclavicular BPB at the costoclavicular space that produces rapid onset of BPB. Future research should compare the safety and efficacy of this new technique with the traditional lateral sagittal infraclavicular BPB. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Addition of Liposome Bupivacaine to Bupivacaine HCl Versus Bupivacaine HCl Alone for Interscalene Brachial Plexus Block in Patients Having Major Shoulder Surgery.

Background and Objectives: We examined whether liposome bupivacaine (Exparel) given in the interscalene brachial plexus block lowers pain in the setting of multimodal postoperative pain management for major shoulder surgery. Methods: Fifty-two adult patients were randomized to receive either 5 mL of 0.25% bupivacaine HCl immediately followed by 10 mL of liposome bupivacaine 133 mg (n = 26) or 15 mL of 0.25% standard bupivacaine alone (n = 26) in interscalene brachial plexus block. The primary outcome (worst pain in the first postoperative week) was assessed by the Modified Brief Pain Inventory short form. Secondary outcomes were overall satisfaction with analgesia (OBAS), functionality of the surgical arm, sleep duration, time to first opioid (tramadol) request and opioid consumption (mEq), sensory-motor block characteristics, and the occurrence of adverse effects. Results: Worst pain was lower in patients given liposome bupivacaine added to standard bupivacaine than in patients given standard bupivacaine alone (generalized estimating equation [GEE] estimated marginal mean values, 3.6 +/- 0.3 vs 5.3 +/- 0.4 points on the Numeric Rating Scale, respectively, although the effect was modest, 1.6 +/- 0.5; 95% confidence interval, 0.8-2.5). Total OBAS scores indicated greater satisfaction (GEE estimated marginal mean values, 1.8 +/- 0.3 vs 3.3 +/- 0.4 on total OBAS, respectively, with modest effect, difference, 1.4 +/- 0.5; 95% confidence interval, 0.5-2.4). There were no differences in any of the other secondary outcomes. Conclusions: Liposome bupivacaine added to standard bupivacaine may lower pain and enhance patient's satisfaction in the first postoperative week even in the setting of multimodal analgesia for major shoulder surgery. This study was registered with clinicaltrials.gov (NCT02554357) on July 11, 2015, by Principal Investigator Catherine Vandepitte, MD. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2jJQ8x6

Αρχειοθήκη ιστολογίου

Σάββατο 4 Φεβρουαρίου 2017

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