Publication date: Available online 11 February 2017
Source:Allergology International
Author(s): Masakazu Ichinose, Hisatoshi Sugiura, Hiroyuki Nagase, Masao Yamaguchi, Hiromasa Inoue, Hironori Sagara, Jun Tamaoki, Yuji Tohda, Mitsuru Munakata, Kohei Yamauchi, Ken Ohta
Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β2-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β2-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.
http://ift.tt/2kVLCci
Σάββατο 11 Φεβρουαρίου 2017
Japanese guidelines for adult asthma 2017
Effectiveness of photodynamic therapy in Bowen's disease: a retrospective observational study in 423 lesions
Abstract
Background
Photodynamic therapy (PDT) is a well-known technique that is often used for treating superficial precancerous and cancerous skin lesions. However, only a handful of studies, with a relatively small number of treated lesions, have been carried out on the effectiveness of PDT for Bowen's disease (BD).
Objectives
This study aimed to assess the effectiveness and recurrence risk of PDT in the treatment of BD. The secondary objectives were to determine what factors affected the response rates and the cosmetic result of the treatment.
Method
In this retrospective observational study, the electronic patient charts at Sahlgrenska University Hospital (SUH) in Gothenburg, Sweden were searched to find all patients diagnosed with BD that were treated with PDT between January 1, 2002 and December 31, 2014. Data was collected regarding clinical response at the first follow-up visit, recurrences during later follow-up visits and other relevant patient and tumour characteristics.
Results
In total, 423 BD lesions in 335 patients were included in the study. The mean FU duration was 11.2 months (range 0.2-151 months). The complete response rate at the first FU visit was 77.5% for all BD lesions. During later FU visits, another 60 recurrences were observed, which resulted in a recurrence rate of 18.3%. Thus, the overall clearance rate after FU was 63.4% for all BD lesions. Significant risk factors for unsuccessful treatment in the present study were large lesion size (>2cm) and a single PDT session.
Conclusion
This study shows that PDT is a relatively effective treatment modality for BD.
This article is protected by copyright. All rights reserved.
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Expression of programmed death-1 in cutaneous extranodal natural killer/T-cell lymphoma and its effect on clinical findings and biological behavior
Abstract
Background
Recent studies have evaluated the expression of programmed death-1 (PD-1) and its prognostic value in malignant T-cell lymphomas.
Objectives
This study investigated whether the positivity of PD-1 was associated with the clinical characteristics of cutaneous extranodal NK/T-cell lymphoma (ENKTL) and evaluated its effects on survival outcomes.
Methods
Forty-one patients with cutaneous ENKTL were included. Clinical features and survival outcomes were analyzed according to the positivity of PD-1.
Results
There was no significant difference between primary cutaneous ENKTL and secondary cutaneous ENKTL in the expression of PD-1. The degree of disease dissemination was not affected by the positivity of PD-1. Higher positivity for PD-1 was associated with lesions presenting erythematous to purpuric patches that are mainly composed of small tumor cells. Cutaneous ENKTL presenting nodular lesions had a significantly lower number of PD-1-positive infiltrating cells than those with other clinical morphologies. There was no significant effect of PD-1 expression on outcomes such as overall and progression-free survival.
Limitations
The present study used a retrospective design and had a small sample size.
Conclusion
Higher PD-1 positivity is associated with small-cell-predominant cutaneous ENKTL. However, PD-1 expression has no prognostic value in cutaneous ENKTL.
This article is protected by copyright. All rights reserved.
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Continuous dosing versus interrupted therapy with ixekizumab: an integrated analysis of two phase 3 trials in psoriasis
Abstract
Background
Continuous treatment is recommended for patients with moderate-to-severe psoriasis, however, treatment may need to be interrupted in routine clinical practice.
Objective
To assess outcomes in patients continuously treated with ixekizumab versus those who interrupted therapy and were subsequently retreated with ixekizumab (IXE).
Methods
This analysis used data pooled from 2 phase 3 trials, UNCOVER-1 and UNCOVER-2. Patients were randomized to placebo (PBO), IXE every 4 (Q4W), or IXE every 2 weeks (Q2W) for 12 weeks. Patients with a static Physician's Global Assessment (sPGA) 0,1 at Week 12 were re-randomized to IXEQ4W, IXE every 12 weeks (not presented), or PBO. We examined outcomes in patients who were continuously treated (IXEQ2W/IXEQ4W; IXEQ4W/Q4W) or withdrawn (IXEQ2W/PBO; IXEQ4W/PBO), and in patients who were withdrawn and retreated with IXEQ4W for 24 weeks after disease relapse (sPGA ≥3).
Results
1226 treated patients achieved an sPGA 0,1 at Week 12 and entered the maintenance phase; of these patients, 402 and 416 were re-randomized to PBO and IXEQ4W, respectively. Among patients interrupting treatment, 157 (82.2%) of IXEQ4W/PBO and 176 (83.4%) of IXEQ2W/PBO had an sPGA ≥3 by Week 60; median time to relapse was approximately 20 weeks irrespective of induction dose. At Week 60, continuously treated patients maintained high levels of PASI and sPGA responses (90.0% PASI 75 IXEQ2W/Q4W; 81.9% sPGA 0,1 IXEQ2W/Q4W, Non-Responder Imputation). After 24 weeks of retreatment with IXEQ4W (IXEQ2W/PBO and IXEQ4W/PBO), 87.0% (107/123) and 95.1% (97/102) (observed), respectively, of patients recaptured PASI 75 and 70.7% (104/147) and 82.3% (107/130) (observed) recaptured an sPGA 0,1. Overall, adverse events in continuously treated and retreated patients were comparable.
Conclusion
High levels of response were sustained with continuous ixekizumab treatment through 60 weeks. Most patients who were withdrawn experienced disease relapse and most of those patients recaptured response after 24 weeks of retreatment.
This article is protected by copyright. All rights reserved.
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Epstein-Barr Virus in the Pathogenesis of Oral Cancers
Abstract
Epstein-Barr virus (EBV) is a ubiquitous gammaherpesvirus that establishes a lifelong persistent infection in the oral cavity and is intermittently shed in the saliva. EBV exhibits a biphasic life cycle, supported by its dual tropism for B lymphocytes and epithelial cells, which allows the virus to be transmitted within oral lymphoid tissues. While infection is often benign, EBV is associated with a number of lymphomas and carcinomas that arise in the oral cavity and at other anatomical sites. Incomplete association of EBV in cancer has questioned if EBV is merely a passenger or a driver of the tumorigenic process. However, the ability of EBV to immortalize B cells and its prevalence in a subset of cancers has implicated EBV as a carcinogenic cofactor in cellular contexts where the viral lifecycle is altered. In many cases, EBV likely acts as an agent of tumor progression rather than tumor initiation, conferring malignant phenotypes observed in EBV-positive cancers. Given that the oral cavity serves as the main site of EBV residence and transmission, here we review the prevalence of EBV in oral malignancies and the mechanisms by which EBV acts as an agent of tumor progression.
This article is protected by copyright. All rights reserved.
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Inducible turnover of optineurin regulates T cell activation
Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Angela Montecalvo, Simon C. Watkins, Jordan Orange, Lawrence P. Kane
Optineurin (Optn) is an adaptor protein with homology to NF-κB essential modulator (NEMO), the regulatory subunit of the IκB kinase (IKK) complex. Dysregulation of Optn has been linked to neurodegenerative, autoimmune and bone diseases. Optn shares a high degree of homology with NEMO, but is not part of the same high-molecular weight complex containing IKKα and IKKβ. Despite its homology with NEMO and the fact that it has been the subject of extensive study in several cell types, there are no published studies addressing the role of Optn during T cell activation. Here we demonstrate that ectopic expression of Optn down-regulates TCR-induced NF-κB activation and TNF-α production, in a manner dependent on ubiquitin-binding. Conversely, knock-down of Optn enhances NF-κB activation and the production of TNF-α. Consistent with a negative regulatory role for this protein, we observed transient loss of Optn after TCR stimulation in both cell lines and in primary murine T cells. The acute loss of Optn appears to be due to both protein degradation and exocytosis, the latter via activation-induced exosomes. This study therefore provides novel information regarding the role of Optn during TCR activation, suggesting the possible importance of Optn during inflammation and/or autoimmune diseases.
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Primary mediastinal large B cell lymphoma in a woman who is human immunodeficiency virus positive presenting with superior vena cava syndrome: a case report
The risk of non-Hodgkin lymphoma is increased 200-fold in individuals seropositive for human immunodeficiency virus compared to those free from human immunodeficiency virus. Human immunodeficiency virus-associ...
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Refractory sleep apnea caused by tubal tonsillar hypertrophy
Publication date: Available online 11 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Seok Chan Hong, Hyun Jin Min, Kyung Soo Kim
Snoring/sleep apnea are usual symptoms of adenotonsillar hypertrophy, and adenotonsillectomy is usually recommended. In rare cases, symptoms remain after surgery, and tubal tonsil hypertrophy could be the cause. We experienced a pediatric patient whose symptoms were refratory snoring/sleep apnea although he previously underwent three times of adenotonsillectomy. We diagnosed tubal tonsil hypertrophy which was the cause of refractory symptoms, and decided to perform volume reduction with radiofrequency ablation. We suggest that tubal tonsil hypertrophy should be taken into account of the cause of refractory sleep apnea after adenotonsillectomy, and volume reduction with radiofrequency may be an effective method.
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A case of acute clival osteomyelitis in a 7-year-old boy secondary to infection of a Thornwaldt cyst
Publication date: Available online 11 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Yasmine Benadjaoud, Nathalie Klopp-Dutote, Morgane Choquet, Elodie Brunel, Raphaël Guiheneuf, Cyril Page
Clival osteomyelitis is a potentially life-threatening infection that can occur in healthy children. It can be related to congenital anomalies. We report the case of a 7-year-old boy with Streptococcus intermedius and Fusobacterium clival osteomyelitis arising from a Thornwaldt cyst situated in a fossa navicularis magna of the occipital bone. Multidisciplinary management is necessary to ensure rapid improvement and complete healing.
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Pycnodysostosis at Otorhinolaryngology
Publication date: Available online 11 February 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Muhammet Fatih Topuz, Adem Binnetoglu, Murat Sarı, Tekin Baglam, Serap Turan
AimPycnodysostosis is a rare autosomal, recessive, skeletal dysplasia caused by a mutation in the cathepsin k gene. Pycnodysostosis is characterized by short stature, characteristic facial appearance (delayed closure of fontanelles and cranial sutures, mandibular hypoplasia and angle disorder, blue sclera), and acroosteolysis of the distal phalanges. Our aim was to describe the otorhinolaryngologic findings, differential diagnoses, various treatment options, and followup in eight cases of pycnodysostosis.MethodThis retrospective clinical study used data from eight patients diagnosed with pycnodysostosis by a single pediatric endocrinologist primarily based on clinical and radiographic findings. All patients were referred to the otorhinolaryngology outpatient clinic by the pediatric endocrinology unit of the Marmara University between February 2013 and March 2015. Detailed medical histories were obtained in all cases and otorhinolaryngologic physical examination, blood assays, electrocardiogram, lateral skull X-rays, chest radiograph, cephalometric investigations, tympanograms, and audiograms were also carried out. Sleep videos of patients were recorded and those with upper airway problems were evaluated for sleep apnea by polysomnography. Informed consent form was obtained from the parents of all patients.ResultsEight patients (7 females and 1 male) displaying proportionate dwarfism were included in the study. They had a mean age of 14.7 years (range: 13-16 y), the mean height of 141.3 cm (range 132-155 cm), and mean weight of 44.4 kg (range: 39.6-49.3 kg). All patients had facial dysmorphism with frontal bossing and the hands and feet had short digits with overlying cutaneous wrinkles that tapered off with large overriding nails. Midfacial hypoplasia and malocclusion were observed in seven of the eight patients (87.5%), four (50%) had micrognathia, and five (62.5%) had proptosis. Tympanograms and audiograms of all patients were type A and normal, and the mean of the pure tone audiogram was 13.3 dB (range: 10-16 dB). All patients had a narrow and grooved palate with disturbed dentition; two of them (25%) had mild markedness of the tongue base, five (62.5%) had grade 3 and three (37.5%) had grade 2 tonsillar hypertrophy, and five (62.5%) had adenoid hypertrophy. One patient (12.5%) had grade 3 Mallampati, four (50%) showed grade 2 Mallampati while three (37.5%) patients displayed grade 1 Mallampati score. Further, while six (75%) patients had no uvular pathology, one (12.5%) patient presented with uvular elongation and another patient had a bifid uvula. Cephalometric measurements such as PAS-UP (mean 5.67 mm; range: 5.0-7.6 mm) and PAS-TP (mean 9.61 mm; range: 8.5 - 12.2 mm) were lower than that of normal subjects. Video recordings showed that six of the eight patients (75%) had respiratory distress and four (50%) had sleep apnea. Polysomnography in these patients with sleep apnea showed that two had mild OSA (AHI: 18.2 and 20.1 events/hour) and two had severe OSA (AHI: 53.4 and 62.8 events/hour). For upper airway problems, an adenotonsillectomy was performed in two (25%) patients while two others required an adenoidectomy. Positive pressure ventilation was recommended in two patients with persistent sleep apnea after adeno/adenotonsillectomy. However, because of the parental objections, the follow-up polysomnographs could not be obtained.ConclusionPycnodysostosis is a very rare form of bone dysplasia. Otorhinolaryngologically, proper follow-up of these patients and appropriate treatment of upper airway problems are important to achieve an acceptable quality of life. Adeno/adenotonsillectomy and positive pressure ventilation, used as conservative approaches in treating upper airway problems, are effective and could be used instead of an aggressive surgery such as tracheotomy or maxillomandibular advancement. This study, to the best of our knowledge, is the largest case series on pycnodysostosis.
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Contralateral Occlusion Test: The effect of external ear canal occlusion on hearing thresholds
Publication date: Available online 10 February 2017
Source:Acta Otorrinolaringológica Española
Author(s): Luis Roque Reis, Paulo Fernandes, Pedro Escada
Introduction and goalsBedside testing with tuning forks may decrease turnaround time and improve decision making for a quick qualitative assessment of hearing loss. The purpose of this study was to quantify the effects of ear canal occlusion on hearing, in order to decide which tuning fork frequency is more appropriate to use for quantifying hearing loss with the Contralateral Occlusion Test.MethodsTwenty normal-hearing adults (forty ears) underwent sound field pure tone audiometry with and without ear canal occlusion. Each ear was tested with the standard frequencies. The contralateral ear was suppressed with by masking. Ear occlusion was performed by two examiners.ResultsParticipants aged between 21 and 30 years (25.6±3.03 years) showed an increase in hearing thresholds with increasing frequencies from 19.94dB (250Hz) to 39.25dB (2000Hz). The threshold difference between occluded and unoccluded conditions was statistically significant and increased from 10.69dB (250Hz) to 32.12dB (2000Hz). There were no statistically significant differences according to gender or between the examiners.ConclusionThe occlusion effect increased the hearing thresholds and became more evident with higher frequencies. The occlusion method as performed demonstrated reproducibility. In the Contralateral Occlusion Test, 256Hz or 512Hz tuning forks should be used for diagnosis of mild hearing loss, and a 2048Hz tuning fork should be used for moderate hearing loss.
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Electroplated telescopic retainers with zirconia primary crowns: 3-year results from a randomized clinical trial
Abstract
Objective
The objective of the study was to investigate the clinical outcome for electroplated telescopic removable dental prostheses (E-RDPs) with zirconia primary crowns.
Materials and methods
Sixty E-RDPs, with primary crowns manufactured from either cobalt–chromium alloy or zirconia, were fabricated for 56 participants. Electroplating was used to produce gold copings directly on the telescopic primary crowns. These copings were bonded intra-orally to the prosthesis framework. After 36 months, prosthesis survival and number of complications were assessed. Statistical analysis was performed by the use of Kaplan–Meier modeling and the log-rank test.
Results
Survival of the E-RDPs, 96.4% after 3 years, was identical in both groups. The need for aftercare was high but not significantly different: technical complications were observed for 37% and 42.9% of the prostheses for the zirconia and cobalt–chromium alloy primary crowns, respectively. Fracture of composite veneer was the most frequent complication (59.1%). The incidence of fractured abutment teeth, decementation, and endodontic problems was 7.9% in the zirconia group and 14% in the control group. The majority of abutment-level complications were treated restoratively. A significant difference was found for maximum probing depth at the abutment teeth: In the zirconia group, it decreased by 0.2 mm, whereas it increased by 0.8 mm in the control group (p = 0.04).
Conclusions
After 3 years of observation, survival of zirconia E-RDPs was favorable and comparable with that of established double-crown-retained prostheses. Further studies must clarify whether there are benefits of zirconia primary crowns for periodontal health.
Clinical relevance
Although these results encourage the use of zirconia primary crowns, more research is necessary to reduce the number of complications observed for secondary telescopic crowns, for example, failure of the veneer.
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Oral health-related quality of life depending on oral health in patients with rheumatoid arthritis
Abstract
Background
The aim of this study was to evaluate the oral health-related quality of life (OHRQoL) in patients with rheumatoid arthritis (RA) depending on their oral health in comparison with healthy controls (HCs).
Methods
One hundred three RA patients (55.5 years, female 58) were included. A healthy control group (HC n = 104; 56.7 years, female 68) was matched according to age, gender, and smoking habits. The OHRQoL was determined by Oral Health Impact Profile (OHIP)-G14 questionnaire. Oral examination included dental findings (DMF-T), gingival inflammation (PBI), periodontal probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP). Based on CAL and/or PPD, periodontitis was categorized as healthy/mild, moderate, or severe. Statistical analysis: trend test (Cochran-Armitage) and Wilcoxon rank-sum test (α = 5%).
Results
For DMF-T (RA 17.6 ± 6.1, HC 16.0 ± 6.5) and PBI (RA 0.10 ± 0.18, HC 0.08 ± 0.18), no significant differences between both groups were found (p > 0.05). Approximately 65% of RA group and 79% of HC group showed moderate to severe periodontitis (p = 0.02); RA patients showed significantly higher BOP values (p < 0.01). OHRQoL was significantly worse in RA group compared to HC group (mean OHIP value RA = 7.3 ± 7.2, HC = 1.6 ± 2.1; p < 0.001). In the HC group, a significant effect of DMF-T, M-T, and PD on OHRQoL was detected (p < 0.01), whereas in the RA group, no influence was determined (p > 0.05).
Conclusion
RA patients showed a worse OHRQoL than HC patients, which was independent of dental and periodontal conditions. RA patients require a more intensive care in consideration of dental, medical, and psychological factors.
Clinical relevance
Interdisciplinary collaboration between dentists and rheumatologists is necessary, whereby psychological factors should be considered.
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Ultrasound-guided peripheral nerve stimulation for neuropathic pain after brachial plexus injury: two case reports
Abstract
Brachial plexus injury (BPI) often causes severe neuropathic pain that becomes chronic and difficult to treat pharmacologically or surgically. Here, we describe two cases of successful treatment of BPI with peripheral nerve stimulation (PNS). Both patients had experienced severe neuropathic pain after incomplete BPI for a long time (32 and 17 years) and did not response to medication, radiofrequency neuroablation, or spinal cord stimulation. After PNS using ultrasound, their pain was relieved by more than 50% over the course of 1 year. Both patients were satisfied with their improved sleep and quality of life. We conclude that PNS could be an alternative therapeutic modality for neuropathic pain after BPI as it provides direct nerve stimulation, has few complications, and is easy to perform.
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Minimizing adjuvant treatment after transoral robotic surgery through surgical margin revision and exclusion of radiographic extracapsular extension: A Prospective observational cohort study
ABSTRACT
Background
We investigated in a prospective cohort of patients treated with trans-oral robotic surgery (TORS) for oropharyngeal cancer (OPC), who were selected for the absence of radiographic extra-capsular extension (ECS) and surgically revised for inadequate margins, the possibility of reducing adjuvant radiation (RT)/chemo-radiation therapy (CRT) without jeopardizing tumor control and functional outcome.
Methods
We conducted a prospective observational cohort of patients treated with TORS for oropharyngeal cancer.
Results
Twenty-nine patients with T1/2N0 to N2B stage cancers were treated with TORS. Forty-five percent of them were treated for secondary primaries. Nine of 29 patients (31%) were revised for close/positive margins. Adjuvant RT was prescribed for 2 of 19 patients with early squamous cell carcinoma (SCCs) and CRT for 1 of 10 patients with advanced oropharyngeal SCCs. Overall survival (OS), disease-specific survival (DSS), and locoregional control at 2 years were 85%, 96%, and 93%, respectively. Posttreatment Functional Outcome Swallowing Scale (FOSS) scores worsened with prior or adjuvant RT, local recurrence, site, and revision for margins.
Conclusion
Patients with early and moderately advanced oropharyngeal SCC selected for radiographic ECS and revised for inadequate margins have excellent tumor control and favorable functional recovery. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
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Predictors of distant metastasis in human papillomavirus–associated oropharyngeal cancer
ABSTRACT
Background
Human papillomavirus (HPV)-positive oropharyngeal cancer is associated with favorable outcomes, prompting investigations into treatment deintensification. The purpose of this study was for us to present the predictors of distant metastases in patients with HPV-positive oropharyngeal cancer treated with cisplatin-based chemoradiotherapy (CRT) or cetuximab-based bioradiotherapy (bio-RT).
Methods
In patients with stage III to IVb HPV-positive oropharyngeal cancer, the Kaplan–Meier analysis was used to calculate distant metastases rates. Univariate analysis (UVA) and multivariate analysis (MVA) were used to identify factors associated with distant metastases.
Results
Increased distant metastases rates were noted in active smokers versus never/former smokers (22% vs 5%), T4 vs T1 to T3 (15% vs 6%), and cetuximab-based bio-RT versus CRT (23% vs 5%). All remained significant on MVA.
Conclusion
T4 tumors and active smokers have substantial rates of distant metastases, and trials investigating intensified systemic therapies may be considered. Higher rates of distant metastases observed with concurrent cetuximab are hypothesis generating, but further data are needed. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
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Space-maintaining management in maxillary sinus lifting: a novel technique using a resorbable polymeric thermo-reversible gel
Publication date: Available online 11 February 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): G. Cossellu, G. Farronato, D. Farronato, G. Ceschel, F. Angiero
Several techniques have been proposed to achieve sinus floor elevation and the formation of new bone through the grafting of autologous, heterologous, or alloplastic materials. The grafted materials act as a scaffold for bone formation inside the maxillary sinus. This study investigated a non-graft sinus lifting procedure using a resorbable polymeric thermo-reversible gel. A space-maintaining approach to sinus lifting, using a resorbable polymeric thermo-reversible gel, was applied in 11 patients undergoing implant treatment in the atrophic posterior maxilla. After a healing period of 6 months, a total of 14 implants were placed; biopsies were taken and evaluated histologically and histomorphometrically. The parameters evaluated included the percentages of new bone formation, residual gel, and fibrous tissue. Histological examination showed the formation of new bone with no fibrous tissue or severe inflammatory cellular infiltration. The percentage of newly formed bone was in the range of 54–60%; this consisted of both lamellar and woven bone. No foreign-body reaction was observed. The mean quantities of both residual gel and connective tissue were small. This non-graft sinus lifting procedure using a space-maintaining gel appears to stimulate predictable bone formation; it is thus a useful technique for promoting bone formation in the sinus.
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Endocultivation: continuous application of rhBMP-2 via mini-osmotic pumps to induce bone formation at extraskeletal sites
Publication date: Available online 10 February 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): B.E. Beck-Broichsitter, S.T. Becker, H. Seitz, J. Wiltfang, P.H. Warnke
The continuous presence of recombinant human bone morphogenetic protein 2 (rhBMP-2) inside a scaffold may be crucial to the outcome in bone tissue engineering. This study investigated whether the release of the growth factor rhBMP-2 via different continuous application schemes influences histomorphological aspects of the hard and soft tissues induced. Three-dimensionally printed hydroxyapatite scaffolds were implanted into one latissimus dorsi muscle of 42 female Lewis rats. Simultaneously implanted mini-osmotic pumps were used to provide a continuous application of rhBMP-2 over 1, 2, or 4 weeks (total dose 200μg). A reference group received rhBMP-2 at the time of implantation only, and a control group received only block implantation. Bone density and histological examinations were performed after 8 weeks. No significant difference in bone density was found between the groups; however, the blood vessel count differed significantly between the groups receiving continuous treatments and both the control group and simultaneous rhBMP-2 treatment group (P<0.0001). Soft tissue types were distributed differently among the study groups. RhBMP-2 application via mini-osmotic pumps is as suitable for inducing bone formation as a single application at the time of implantation. The time interval over which rhBMP-2 was administered had no impact on the amount of new bone formation, probably due to the study duration and low local concentrations of growth factor.
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Facial nerve paralysis after super-selective intra-arterial chemotherapy for oral cancer
Publication date: Available online 10 February 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Sugiyama, T. Iwai, S. Oguri, T. Koizumi, K. Mitsudo, I. Tohnai
Facial nerve paralysis (FNP) after super-selective intra-arterial chemotherapy (SSIAC) is a relatively rare local side effect of SSIAC to the maxillary artery (MA) or the middle meningeal artery (MMA). The incidence and prognosis of FNP after SSIAC in 381 patients with oral cancer (133 with catheterization of the MA, 248 without) was investigated retrospectively. Only three patients (two male and one female) had FNP, for an incidence of 0.8%. All patients with FNP had undergone catheterization of the MA, and the incidence of FNP in this group was 2.3% (3/133). One of the three patients with FNP had paralysis of the third branch of the trigeminal nerve. FNP occurred a mean of 8.7 days (range 5–11 days) after initial SSIAC, and the mean total dose of cisplatin was 55.8mg (range 42.5–67.2mg) and of docetaxel was 25.4mg (range 17.0–33.6mg). FNP resolved completely a mean of 12.7 months (range 6–19 months) after onset. Because the administration of anticancer agents via the MA or MMA carries a risk of FNP, this information will be useful when obtaining informed consent from patients before treatment.
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Comparison of laser and ozone treatments on oral mucositis in an experimental model
Abstract
Oral mucositis (OM) induces severe pain and limits fundamental life behaviors such as eating, drinking, and talking for patients receiving chemotherapy or radiotherapy. In addition, through opportunistic microorganisms, OM frequently leads to systemic infection which then leads to prolonged hospitalization. Severe lesions often adversely affect curative effects in cancer cases. Therefore, the control of OM is important for oral health quality of life and prognosis. Low-level laser therapy (LLLT) and ozone may be useful to accelerate wound healing. In this study, 24 Sprague-Dawley rats were divided into three groups as control, ozone, and laser groups. All groups received 5-fluorouracil intraperitoneally and trauma to the mouth pouch with a needle. After the formation of OM in the mouth, the control group had no treatment; the ozone group was administered ozone, and the laser group, LLLT. Then, all groups were sacrificed and basic fibroblast growth factor (bFGF), transforming growth factor (TGF-β), and platelet-derived growth factor (PDGF) were evaluated in all groups. LLLT was determined to be statistically significantly more effective than ozone on FGF and PDGF. However, in respect of TGF-β, no statistically significant difference was observed between the groups. In conclusion, within the limitations of this study, LLLT is more effective than ozone. However, further studies on this subject are required.
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Comparison of fiber delivered CO 2 laser and electrocautery in transoral robot assisted tongue base surgery
Abstract
To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea–hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.
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LRRC8A-dependent volume regulated anion channel activity is dispensable for T cell development and function
Publication date: Available online 10 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Craig D. Platt, Janet Chou, Patrick Houlihan, Yousef R. Badran, Lalit Kumar, Wayne Bainter, P. Luigi Poliani, Carlos J. Perez, Sharon Y.R. Dent, David E. Clapham, Fernando Benavides, Raif S. Geha
BackgroundLeucine-rich repeat containing 8A (LRRC8A) is a ubiquitously expressed transmembrane protein with 17 LRRs at its C-terminal end, and is an essential component of the volume regulated anion channel (VRAC) which controls cellular volume. A heterozygous mutation in LRRC8A that truncates the two terminal LRRs was reported in a patient with agammaglobulinemia and absent B cells, and was demonstrated to exert a dominant negative effect on T and B cell development in mice. Lrrc8a-/- mice have severely defective T cell development and function. It is not known whether the T and B cell defects caused by LRRC8A deficiency are caused by loss of VRAC activity.ObjectiveTo determine whether VRAC activity is required for normal T cell development and function.MethodsVRAC activity was examined by patch clamp analysis. Flow cytometry was used to examine T cell development. T cell proliferation, cytokine secretion and antibody titers were measured by standard techniques.ResultsWe demonstrate that the spontaneous mouse mutant ébouriffé (ebo/ebo) harbors a homozygous 2 bp frameshift mutation in Lrrc8a that truncates the fifteen terminal LRRs of LRRC8A. The LRRC8Aebo mutation does not impact protein expression but drastically diminishes VRAC activity in T cells. ebo/ebo mice share features with Lrrc8a-/- mice that include curly hair, infertility, reduced longevity and kidney abnormalities. However, in contrast to Lrrc8a-/- mice, ebo/ebo mice have normal T cell development and function and intact antibody response to T-dependent antigen.ConclusionLRRC8A-dependent VRAC activity is dispensable for T cell development and function.
Teaser
The role that LRRC8A plays in T cell development is independent of its role in regulating cellular volume.http://ift.tt/2kDjCM1
Autoimmune and inflammatory manifestations occur frequently in primary immunodeficiencies
Publication date: Available online 10 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Alain Fischer, Johan Provot, Jean-Philippe Jais, Alexandre Alcais, Nizar Mahlaoui
BackgroundPrimary immunodeficiencies (PIDs) are inherited diseases associated with a considerably increase in susceptibility to infections. It is known that PIDs can also predispose to cancer and immune diseases including allergy, autoimmunity and inflammation.Objective: We aimed at determining the incidence of autoimmunity and inflammation in PID patients.Methods: We have retrospectively screen 2183 consecutive cases of PID in the French CEREDIH registry for the occurrence of autoimmunity and inflammation.Results: One or more autoimmune and inflammatory complications were noted in 26.2% of patients, with a risk of onset throughout the patient's lifetime. The risk of autoimmune cytopenia was at least 120 times higher than in the general population, the risk of inflammatory bowel disease in children 80 times higher and the risk of other autoimmune manifestations was approximately 10 times higher. Remarkably, all types of PID were associated with a risk of autoimmune and inflammatory complications, although the greatest risk was associated with T cell PIDs and common variable immunodeficiency. The occurrence of autoimmune disease is a negative prognostic factor for survival.ConclusionsOur results provide the basis for a detailed, prospective evaluation of autoimmunity and inflammation in the context of PID, with a view to accurately assessing these risks and describing the possible impact of medical intervention.
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Population-based Familial Aggregation of Eosinophilic Esophagitis Suggests a Genetic Contribution
Publication date: Available online 10 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Kristina Allen-Brady, Rafael Firszt, John C. Fang, Jathine Wong, Ken R. Smith, Kathryn A. Peterson
BackgroundPrior familial clustering studies have observed an increased risk of eosinophilic esophagitis (EoE) mostly among first-degree relatives suggesting a genetic contribution to EoE, and twin studies have suggested a powerful contribution from environmental factors.ObjectiveClarify the contribution of genetic factors to EoE through estimation of familial aggregation and risk of EoE in extended relatives.MethodsThe Utah Population Database, a population-based genealogy resource linked to electronic medical records for healthcare systems across the state of Utah, was used to identify EoE cases and age, sex and birthplace-matched controls at a 5:1 ratio. Logistic regression was used to determine the odds of EoE among relatives of EoE probands compared to the odds of EoE among relatives of controls.ResultsThere were 4,423 EoE cases and 24,322 controls. The population attributable risk of EoE was 31% (95% CI 28-34%), suggesting a relatively strong genetic contribution. Risks of EoE were significantly increased among first-degree relatives (OR=7.19; 95% CI 5.65–9.14), particularly first-degree relatives of EoE cases diagnosed <18 years of age (OR=16.3; 95% CI 9.4-28.3); second-degree relatives (OR=1.99; 95% CI 1.49-2.65); and first cousins (OR=1.35; 95% CI 1.03-1.77), providing evidence of a genetic contribution. However, spouses of EoE probands were observed to be at increased risk of EoE (OR=2.86; 95% CI 1.31-6.25), suggesting either positive assortative mating or a shared environmental contribution to EoE.ConclusionThis study supports a significant genetic contribution to EoE as evidenced by increased risk of EoE in distant relatives.
Teaser
This study provides evidence of a genetic contribution to eosinophilic esophagitis as indicated by excess familial clustering of the disease in both close and distant relatives.http://ift.tt/2kDfJ9V
Something New in the Air: Paying for Community-Based Environmental Approaches to Asthma Prevention and Control
Publication date: Available online 10 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Megan M. Tschudy, Joshua Sharfstein, Elizabeth Matsui, Charles S. Barnes, Stacey Chacker, Rosa Codina, John R. Cohn, Megan Sandel, H. James Wedner
Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. Emerging payment approaches, however, offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes and their key characteristic is a focus on the value rather than the volume of services. These new payment models for environmental interventions can be divided into two categories: enhanced fee-for-service reimbursement and set payments per patient that cover asthma-related costs. Several pilot programs across the United States are underway, and as they prove their value and as payment increasingly becomes aligned with better outcomes at lower cost, these efforts should have a bright future. Physicians should be aware that these new possibilities are emerging for payment of the goods and services needed for indoor environmental interventions for their patients with asthma.
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Systemic Innate Immune Activation in Food Protein Induced Enterocolitis Syndrome (FPIES)
Publication date: Available online 10 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Ritobrata Goswami, Ana Belen Blazquez, Roman Kosoy, Adeeb Rahman, Anna Nowak-Wegrzyn, M. Cecilia Berin
BackgroundFood protein induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy of infancy whose pathophysiology is poorly understood.ObjectivesWe set out to identify and phenotype allergen-responsive cells in peripheral blood of a cohort of subjects undergoing supervised food challenge for FPIES.MethodsWe profiled antigen-responsive cells in peripheral blood mononuclear cells by flow cytometry, and examined cells in whole blood obtained before and after challenge by CyTOF mass cytometry and RNAseq.ResultsUsing a CD154-based detection approach, we observed that milk, soy, or rice-responsive T cells, and TNFα-producing CD154+ T cells were significantly lower in those with outgrown FPIES compared to active FPIES. However, levels were within the normal range and were inconsistent with a role in the pathophysiology of FPIES. Profiling of whole blood by CyTOF demonstrated profound activation of cells of the innate immune system after food challenge, including monocytes, neutrophils, NK cells, and eosinophils. Activation was not observed in children with outgrown FPIES. We confirmed this pattern of innate immune activation in a larger cohort by RNAseq. Furthermore, we observed pan-T cell activation and redistribution from the circulation after a positive food challenge but not in those who had outgrown their FPIES.ConclusionsOur data demonstrate a compelling role of systemic innate immune activation in adverse reactions elicited by foods in FPIES. Further investigation is needed to identify the mechanism of antigen specificity of adverse reactions to foods in FPIES.
Teaser
Using blood obtained before and after food challenges for FPIES, we show that individuals with symptoms in response to challenge have activation of neutrophils, monocytes, eosinophils, and NK cells that is not observed in those who have outgrown FPIES. This novel finding places the innate immune system at the center of FPIES pathogenesis.http://ift.tt/2kDaTt7
Meeting Announcement
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
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Staphylococcus Aureus Colonization Is Associated with Increased Atopy and Inhaled Steroid Use in Patients with Atopic Dermatitis and Asthma
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Peter Uong, Douglas Curran-Everett, Donald Y.M. Leung
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Oxidative stress induces fibrotic reactions in Atp8b1 mutant mice through abnormal behavior of Club cells
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Jutaro Fukumoto, Andrew J. Cooke, Ramani Soundararajan, Richard F. Lockey, Narasaiah Kolliputi
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Chronic Rhinitis Is A Strong Clinical Predictor for Early Hospital Readmission Of Chronic Obstructive Lung Disease Patients
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Umesh Singh, Victoria Wangia-Anderson, Linda Levin, Jonathan A. Bernstein
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IL-22 Generated in Response to Cutaneous Sensitization Drives Neutrophilic Airway Inflammation Following Antigen Inhalation in a Mouse Model of Atopic Dermatitis
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Juan-Manuel Leyva-Castillo, Juhan Yoon, Raif Geha
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The activation of transient receptor potential melastatin 8 (TRPM8) receptors induces airway inflammation in bronchial asthma
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Joo-Hee Kim, Young-Sook Jang, Ji Young Park, Yong Il Hwang, Sunghoon Park, Seung-Hun Jang, Ki-Suck Jung, Hae-Sim Park
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A composite of exhaled eicosanoids is associated with childhood asthma and its convalescence
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Li-Chen Chen, H.M. Tseng, M.L. Kuo, Ai-Hsuan Wu, Kuo-Wei Yeh, Jing-Long Huang, Shau-Ku Huang
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Presence of Cytomegalovirus DNA in the Whole Blood Is Associated with the Risk of Bronchial Asthma
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Marek L. Kowalski, Aleksandra Wardzynska, Miroslawa Studzinska, Malgorzata Pawelczyk, Zbigniew Jan Lesnikowski, Edyta Paradowska
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IL10 Genetic Variants Are Associated With House Dust Mite-Allergy But Not Directly On Asthma In A Severe Asthma Case-Control Study
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Héllen Freitas Fonseca, Ryan Santos Costa, Tamires Cana Brasil Carneiro, Regina Santos Nascimento, Gerson Almeida Queiroz, Anaque Oliveira Pires, Alvaro Augusto Cruz Filho, Camila Alexandrina Figueiredo
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Title Page
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
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Effect of age and asthma on Treg cell function
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Janette Birmingham, Juan Wisnivesky, Paula J. Busse
http://ift.tt/2kgfNsG
Wnt7b/Beta-Catenin Signal Pathway Associated with Airway Remodeling of Asthma Rats
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Weixi Zhang, Tingting Zhu, Xiaoxiao Jia, Cuiye Weng, Changchong Li, Wei Zhao
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Table of Contents
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
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Variants in OXA1L Gene Are Associated With Asthma And Atopy in a Latin Population
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Anaque Oliveira Pires, Milca Jesus Silva, Maria Borges Rabelo Santana, Raimon Rios Silva, Hugo Bernardino Ferreira Silva, Norma Vilany Queiroz Carneiro, Gerson Almeida Queiroz, Héllen Freitas Fonseca, Sandro Oliveira Dias, Ryan Santos Costa, Mauricio Lima Barreto, Camila Alexandrina Figueiredo
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IL1RL1 Variants rs1041973 and rs873022 are Associated With Allergy Markers and Soluble ST2 Production in a Brazilian Population
Publication date: February 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 2, Supplement
Author(s): Gerson Almeida Queiroz, Ryan Santos Costa, Valdirene Leao Carneiro, Talita Santos Jesus, Neuza Maria Alcântara-Neves, Anaque Oliveira Pires, Héllen Freitas Fonseca, Mauricio Lima Barreto, Camila Alexandrina Figueiredo
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Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications.
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European Society of Anaesthesiology evidence-based and consensus-based guidelines on postoperative delirium.
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Donkey's milk allergy
A 25 years-old woman, with a history of personal atopic dermatitis, allergic asthma and hay fever, experienced a facial angioedema 5 minutes after consuming fresh donkey's milk for the first time (Fig. 1). She developed dyspnea and collapsed after a few minutes. The patient required administration of adrenaline and corticosteroids. During her childhood, her atopic dermatitis was treated with different topical treatments including donkey's milk based emollients. She never presented reactions to this topical treatment and she had no history of food allergy.
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