Τετάρτη 22 Φεβρουαρίου 2017
EACMFS Prizes and Awards
The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.
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Honokiol protects skin cells against inflammation, collagenolysis, apoptosis, and senescence caused by cigarette smoke damage
Abstract
Background
Pollution, especially cigarette smoke, is a major cause of skin damage.
Objectives
To assess the effects of the small molecule polyphenol, honokiol, on reversing cigarette smoke-induced damage in vitro to relevant skin cells.
Methods
Keratinocytes (HaCat) cultures were exposed to cigarette smoke and, after 48 hours, IL-1α and IL-8 were measured in cell supernatants. Moreover, TIMP-2 production, apoptosis rate, and senescence β-galactosidase expression were evaluated in primary human foreskin fibroblasts (HFF-1) cultures.
Results
Honokiol at 10 μm reduced IL-1α production by 3.4 folds (P < 0.05) and at 10 and 20 μm reduced IL-8 by 23.9% and 53.1% (P < 0.001), respectively, in HaCat keratinocytes. In HFF-1, honokiol restored TIMP-2 production by 96.9% and 91.9% (P < 0.001), respectively, at 10 and 20 μm, as well as reduced apoptosis by 47.1% (P < 0.001) and 41.3% (P < 0.01), respectively. Finally, honokiol reduced senescence-associated β-galactosidase expression in HFF-1.
Conclusion
Honokiol protects both HFF-1 and HaCat against cigarette smoke-induced inflammation, collagenolysis, apoptosis, and senescence.
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Expression levels of transcription factor PU.1 and interleukin-9 in atopic dermatitis and their relation to disease severity and eruption types
Abstract
Background
The role of immunological factors in atopic dermatitis (AD) pathogenesis is well established. T-helper (TH) cells are central in AD pathogenesis. A relatively new subset of T cells, Th9 cells, was shown to be involved in the development of allergic asthma and allergic rhinitis, while its role in AD is still to be investigated. This study aimed to measure gene expression levels of interleukin-9 (IL-9) and PU.1, and to examine relationships with disease severity, serum IgE, and eruption types in AD patients.
Methods
The study enrolled 30 AD patients, 30 psoriasis patients, and 30 healthy subjects. The severity of AD was assessed using the SCORAD index. IL-9 and PU.1 expressions were measured by using real-time quantitative polymerase chain reaction (RQ-PCR). Serum IgE was measured by IgE (human) enzyme-linked immunosorbent assay (ELISA) Kit.
Results
IL-9 and PU.1 gene expressions were significantly higher in AD patients than in controls (P1 = 0.007, P2 < 0.001, respectively). In the atopic dermatitis patients, expression of IL-9 and PU.1 were significantly positively correlated with SCORAD index (P1 = 0.004, P2 = 0.002) and clinically with erythema and edema scores. IL-9 and PU.1 expressions were positively significantly correlated (P = 0.005) and positively correlated with serum IgE in the AD group (P1 = 0.017, P2 = 0.023). No significant difference was noted between AD patients with or without histories of other atopies regarding expression levels of IL-9 and PU.1 (P1 = 0.677, P2 = 0.135).
Conclusions
PU.1 and IL-9 may play a role in AD pathogenesis and relate to disease severity and clinical eruption types.
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The Concerted Action of Type 2 and Type 3 Deiodinases Regulates the Cell Cycle and Survival of Basal Cell Carcinoma Cells
Thyroid , Vol. 0, No. 0.
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Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer Over a Decade: How Many Surgeries and Complications Can Be Avoided?
Thyroid , Vol. 0, No. 0.
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The efficiency and adverse events of radiotherapy with cetuximab for Japanese head and neck cancer patients
Radiotherapy with cisplatin (Chemoradiotherapy, CRT) has long been one of the standard treatments for head and neck squamous cell cancer (HNSCC). Approval of cetuximab for the treatment of HNSCC has made radiotherapy with cetuximab (Bioradiotherapy, BRT) a new treatment option for HNSCC. Reports of BRT in the Japanese written in English up to now is only the phase II study, though it includes only 22 patients. Also on the nature of the clinical Phase II trial, sampling bias of cases may exist. Here we report the treatment completion rate, response rate and frequency of adverse events of BRT in Japanese patients with HNSCC in English for the first time.
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Dermal morphological changes following salicylic acid peeling and microdermabrasion
Summary
Background
Microdermabrasion and chemical peeling are popular, inexpensive, and safe methods for treatment of some skin disorders and to rejuvenate skin.
Objectives
To study the alterations of the dermal connective tissue following salicylic acid peeling and microdermabrasion.
Methods
Twenty patients were participated in our study. All participants underwent facial salicylic acid 30% peel or microdermabrasion (10 cases in each group) weekly for 6 weeks. Punch biopsies were obtained from the clinically normal skin of the right postauricular region 1 week before treatment (control group). Other punch skin biopsies were obtained 1 week after the end of the treatments from the left postauricular area. This region was treated in a similar way to the adjacent lesional skin (treated group). We used routine histological techniques (H&E stain), special stains (Masson trichrome and orcein stains), and image analyzer to study the alterations of the dermal connective tissues.
Results
Our study demonstrates variations in the morphological changes between the control and the treated groups, and between chemical peels and microdermabrasion. Both salicylic acid 30% and microdermabrasion were associated with thickened epidermal layer, shallow dermal papillae, dense collagen, and elastic fibers. There was a significant increase among those treated sites vs control regarding epidermal thickness and collagen thickness. Also, there was a highly statistically significant increase among those treated with salicylic acid vs microdermabrasion regarding the epidermal, collagen, and elastin thickness.
Conclusions
Both methods stimulate the repair process. The mechanisms underlying these variations are open for further investigations.
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Comparison of digital panoramic radiography versus cone beam computerized tomography for measuring alveolar bone
Abstract
Background
Cone beam computerized tomography (CBCT) has been widely used in dental implanting. However, the local hospitals usually don't have access to CBCT due to the cost and medical investment, especially in West of China. The doctors in local hospitals have to make reasonable dental planting using orthopantomography (OPG) to reduce risks. Therefore, it is clinically meaningful to determine the magnification rate of OPG to obtain correct diagnosis. This study investigated the magnification rate of OPG in measuring different maxillofacial loci compared with CBCT.
Methods
Eighty-six patients demanding dental implanting were scanned by CBCT and OPG. The vertical distance between the alveolar ridge crest of the maxillary first molar and the sinus bottom of the upper jaw, the distance between the alveolar ridge crest of the mandibular first molars and the top of nerviduct in the mandibular alveolar, and the distance between the alveolar ridge crest of the maxillary central incisors and the bottoms of the nasal cavities were measured. The horizontal distance in those loci were also measured. The distances derived from CBCT were used as reference. The distances between the two methods were compared using paired t-test. The magnification rates at these positions were calculated. The relationship between the data acquired from the two methods was analyzed Pearson correlation.
Results
The correlation coefficients (R) between the paired samples obtained from OPG and CBCT were highly related (P < 0.05) with R values varying from 0.840 and 0.959 in vertical distances and R values varying from 0.703 and 0.904 in horizontal distances. Compared with data obtained from CBCT, the mean vertical magnification rates were 11.38% and 12.95% vertically and 8.55% and 9.43% horizontally for the first molars in the right and left maxilla respectively; 7.26% and 6.35% vertically and 5.33% and 4.96% horizontally for the first molars in the right and left mandible respectively; and 5.55% and 4.84% vertically and 6.53% and 7.47% horizontally for the central incisors in the upper right and left jaws respectively.
Conclusion
The magnification rates of OPG at these teeth are different. The distances measured by OPG were highly correlated with that measured by CBCT.
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The Correlation of Arterial Stiffness with Biophysical Parameters and Blood Biochemistry
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
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Alanine Aminotransferase Is a Marker of Lipotoxicity Consequences and Hyperandrogenemia in Women with Polycystic Ovary Syndrome
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
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Randomized study on the effect of single-implant versus two-implant retained overdentures on implant loss and muscle activity: a 12-month follow-up report
The objective was to evaluate and compare single- and two-implant retained overdentures for the rehabilitation of the edentulous mandible. Fifty-six edentulous subjects were eligible for inclusion. Using a random sampling system, a single implant or two implants were placed in the mandible. After 3 months, locator attachments were connected to the implants and the denture delivered with the retentive components incorporated in the denture base. Implant failure and muscle activity were evaluated at the 3-, 6-, and 12-month follow-up examinations.
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Multiple and recurrent squamous cell carcinoma of the oral cavity after graft-versus-host disease
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Weng Xiu Hong, Zhen Xing Yu, Bo Cheng
Oral squamous cell carcinoma (OSCC) is one of the most common secondary solid tumors in patients with hematopoietic stem cell transplantation (HSCT). However, according to previous reports, multiple and recurrent OSCC is very rare. The case presented here shows the susceptibility of patients who present with chronic graft-versus-host disease (cGVHD) after HSCT to the development of secondary malignancies, particularly oral cancer. OSCC after HSCT appears to be more invasive and has a tendency to recur, with a poor prognosis. Therefore, regular and thorough evaluations of the oral mucosa are recommended for all patients who undergo bone marrow transplantation (BMT) and are suffering from cGHVD.
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The efficiency and adverse events of radiotherapy with cetuximab for Japanese head and neck cancer patients
Source:Auris Nasus Larynx
Author(s): Kazuhiro Hirasawa, Isaku Okamoto, Ray Motohashi, Hiroki Sato, Soichiro Takase, Ayumi Agata, Atsuo Takeda, Kiyoaki Tsukahara
ObjectivesRadiotherapy with cisplatin (Chemoradiotherapy, CRT) has long been one of the standard treatments for head and neck squamous cell cancer (HNSCC). Approval of cetuximab for the treatment of HNSCC has made radiotherapy with cetuximab (Bioradiotherapy, BRT) a new treatment option for HNSCC. Reports of BRT in the Japanese written in English up to now is only the phase II study, though it includes only 22 patients. Also on the nature of the clinical Phase II trial, sampling bias of cases may exist. Here we report the treatment completion rate, response rate and frequency of adverse events of BRT in Japanese patients with HNSCC in English for the first time. In association with this, we examine the issues related to BRT in Japanese patients.Patients and methodsThe subjects consisted of patients with HNSCC who underwent BRT as the first curative treatment (45 cases). Their treatment completion rate, response rate and frequency of adverse events were examined.ResultsOf the 45patients, 42 were male and 3 were female. The mean age of the patients was 64 (range from 40 to 86). Adverse events of Grade3 or more were 12 cases (27%) of dermatitis, 31 cases (69%) of mucositis/stomatitis, 6 cases (13%) of interstitial pneumonia. The complication rate of pulmonary emphysema in those who developed interstitial pneumonia and those who did not were 83% and 21%, respectively. The BRT completion rate was 78%, and the response rate was 84%.ConclusionBRT is sufficiently tolerable and have high response rate even for the Japanese, but we should recognize that BRT is not a minimally invasive and easily manageable treatment.
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Endoscopically assisted extracapsular dissection of pleomorphic adenoma of the parotid gland through a postauricular sulcus approach in young patients
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): W.-l. Chen, S. Fan, D.-m. Zhang
We evaluated the aesthetic outcomes in 11 young patients (mean (range) age 21.7 (16–28) years) who had endoscopically assisted extracapsular dissection of benign pleomorphic adenomas of the parotid gland through a postauricular sulcus approach. The tumours varied in size from 1.5×1.0cm to 2.5×2.0cm, and all were removed completely without rupture. The cosmetic result was excellent in 10 patients and good in one. Patients were followed up for eight to 40 months, and there was no recurrence. The technique is simple and feasible, and it achieves excellent aesthetic results in young patients.
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Cutaneous Lymphadenoma: A Trichoblastoma with Regressive Inflammatory Changes
Facial plast Surg 2017; 33: 109-111
DOI: 10.1055/s-0036-1597951
The authors address the entity of cutaneous lymphadenoma. Although considered benign, cutaneous lymphadenoma can be easily misdiagnosed as basal cell carcinoma because of its close clinical and histological resemblance. This entity is rare and controversial both in terms of its histogenesis and the various diagnostic terms assigned to it throughout the literature. While rare, cutaneous lymphadenoma should be considered in the differential of any facial nodule or papule in addition to the more common basal cell carcinoma, nevi, cysts, and appendiceal tumors.
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Nasal Anatomy and Function
Facial plast Surg 2017; 33: 003-008
DOI: 10.1055/s-0036-1597950
The nose is a complex structure important in facial aesthetics and in respiratory physiology. Nasal defects can pose a challenge to reconstructive surgeons who must re-create nasal symmetry while maintaining nasal function. A basic understanding of the underlying nasal anatomy is thus necessary for successful nasal reconstruction.
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Trends in Nasal Subunit Reconstruction by Facial Plastic and Reconstructive Surgeons
Facial plast Surg 2017; 33: 017-019
DOI: 10.1055/s-0036-1597683
To determine if facial plastic and reconstructive surgeons still adhere to the classic nasal subunit principle as described by Burget and Menick. Observational survey. A Weill Cornell Medicine institutional review board approved electronic survey that was sent via e-mail to active members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The survey consisted of 32 multiple-choice questions pertaining to the operative management of small (22–30%), medium (50–58%), and large (75–81%) defects of each subunit of the nose, as well as demographic, provider, and practice characteristics. There were 111 responses to the survey (10.1% response rate). Ninety-eight percent of respondents reported familiarity with the subunit principle, and 59.6% considered the subunit principle in greater than 90% of cases. Almost three-quarters (70.4%) of respondents felt the subunit principle should be applied but could be modified based on the particular nasal defect, whereas 28.7% felt it was only sometimes helpful and was not mandatory for successful nasal reconstruction. Large defects of the tip and ala are generally treated by excision of the remaining subunit (79.4 and 80.6%, respectively). Fewer surgeons would excise the remaining subunit for large defects of the dorsum (39.8%), sidewall (38.8%), and soft tissue facet (18.4%). Simple repair without additional excision was the treatment of choice for small defects of the tip (58.2%), ala (59.2%), sidewall (65%), dorsum (68%), and soft tissue facet (71.8%). However, in many small- (up to 32%) and medium- (up to 51%) sized defects of the tip, ala, sidewall, and dorsum, respondents reported partial subunit excision. The majority of AAFPRS members abide to the classical subunit principle by completely excising the remaining subunit for large defects of the tip and ala. Many surgeons modify the subunit principle in small and medium defects.
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Principles of Nasal Reconstruction
Facial plast Surg 2017; 33: 009-016
DOI: 10.1055/s-0036-1597949
The rise in cutaneous malignancies over the past 20 years has led to significant advances in reconstructing the nose from an aesthetic and functional standpoint. The principles of nasal reconstruction center on application of the nasal subunit principle, three-layered reconstruction, nasal skin characteristics, and patient factors. Reconstructive planning starts with proper defect analysis, followed by application of the reconstructive ladder for soft-tissue repair, adequate structural support, and repair of nasal lining deficits. Optimal reconstructive methods depend on the location and size of the defect. Finally, refinement of the reconstruction is achieved through dermabrasion, scar revision, and flap thinning techniques.
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Delayed Facial Nerve Paralysis following Blast Trauma
Facial plast Surg 2017; 33: 116-118
DOI: 10.1055/s-0036-1597983
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Using Grafts and Granulation to Improve Nasal Repair
Facial plast Surg 2017; 33: 020-026
DOI: 10.1055/s-0036-1597948
Skin grafts offer a dynamic repair option for nasal defects of appropriate size, depth, and location. Granulation and grafting can successfully be used as stand-alone reconstructive options or in conjunction with flap repair. This article reviews suitable indications for graft and granulation use in nasal repair to achieve optimum functional and esthetic outcomes.
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Applying a Visual Assessment Tool to Facial Linear Scars
Facial plast Surg 2017; 33: 097-101
DOI: 10.1055/s-0036-1597684
Previous scar scales have focused on verbal descriptions. A nonverbal visual assessment tool would provide a simple way for patients and physicians to quantify scar appearance. The authors sought to use a validated visual assessment tool for linear surgical scars to assess linear scars on the face and to determine whether patients and surgeons rate scars similarly. A total of 143 patients with linear facial scars resulting from repair of Mohs micrographic surgery defects used the visual assessment tool to rate their surgical scar. Six physicians used the tool to rate a subset of the patients' scar photographs. The scar ratings for patients and physicians were compared. Among the scars rated by both the patients and physicians (n = 79), patients had a significantly lower mean (i.e., more favorable) rating compared with the physicians. This was a single-center study including only Caucasian patients. The visual assessment tool to rate linear surgical scars provided a simple method for both patients and physicians to assess the overall appearance of postsurgical scars. Difference in the scar ranking between patients and physicians indicate the importance of incorporating both patient and physician point of view when assessing scars.
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Local Cutaneous Flaps in Nasal Reconstruction
Facial plast Surg 2017; 33: 027-033
DOI: 10.1055/s-0036-1597982
Facial plastic surgeons use a variety of reconstruction techniques to overcome challenges in restoring the function, structural integrity, and intricate nasal contour in nasal reconstruction. Local cutaneous flaps provide excellent skin texture, thickness, and color match in nasal reconstruction. They offer an excellent cosmetic appearance for small- to medium-sized defects and are preferentially utilized when feasible. This article aims to provide an updated review of local cutaneous flaps for nasal defect repair and describe the major principles related to flap selection.
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Nasal Reconstruction
Facial plast Surg 2017; 33: 001-002
DOI: 10.1055/s-0037-1598090
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Interpolated Flaps
Facial plast Surg 2017; 33: 034-042
DOI: 10.1055/s-0037-1598170
Nasal reconstruction has been articulated in the literature since 700 B.C. when the earliest iteration of the forehead flap was described in the Indian medical treatise, the Sushruta Samhita. Since then it has evolved into the interpolated flap which has served as a powerful tool for facial reconstruction. The interpolated flap is constructed from nonadjacent donor tissue that has an inherent blood supply. It requires a multistaged approach and is best suited for reconstruction of large or deep defects of the nose. There are three types of interpolated flaps used for nasal reconstruction: the forehead, melolabial, and nasofacial interpolation flaps. The nose is the central feature of the human face and its placement is both aesthetic and functional. Any defects owing to accidental or iatrogenic trauma can cause physiologic and psychological injury to patients. This article aims to review the aforementioned flaps and give indications, contraindications, procedure details, and future directions of these flaps.
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Adjuncts to Improve Nasal Reconstruction Results
Facial plast Surg 2017; 33: 082-086
DOI: 10.1055/s-0036-1597899
The final cosmetic appearance of nasal reconstruction scars is of paramount importance to both the patient and surgeon. Ideal postreconstruction nasal scars are flat and indistinguishable from surrounding skin. Unfortunately, even with meticulous surgical execution, nasal scars can occasionally be suboptimal. Abnormal fibroblast response can lead to hypertrophic nasal scars, and excessive angiogenesis may lead to telangiectasias or an erythematous scar. Imperfect surgical closure or poor postoperative management can lead to surgical outcomes with step-offs, depressions, suture marks, or dyspigmentation. Aesthetically unacceptable nasal scars can cause pruritus, tenderness, pain, sleep disturbance, and anxiety and depression in postsurgical patients. Fortunately, there are several minimally invasive or noninvasive techniques that allow for enhancement and improvement of cosmetic results with minimal risk and associated downtime. This article provides an overview of adjuncts to improve nasal reconstruction with a focus on techniques to be used in the postoperative period. Armed with an understanding of relevant available therapies, skillful surgeons may drastically improve the final cosmesis and outcome of nasal reconstruction scars.
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Osseous and Cartilaginous Nasal Reconstruction
Facial plast Surg 2017; 33: 043-051
DOI: 10.1055/s-0036-1597897
The nose is a complex, three-dimensional structure that is supported by a framework of osseous and cartilaginous structures. Disruption of this framework can result in nasal deformity and functional deficits. Nasal reconstruction requires restoration of the osseous and cartilaginous framework. This requires careful preoperative assessment of the nasal defect and understanding the nasal and facial aesthetics that are supported by the osseous and cartilaginous support structures. Structural grafts can be classified as restorative, supportive, or contouring. Surgeons must understand the requirements for each type of grafting and which materials to use to provide the necessary structural reconstruction. Autogenous, homologous, and allogenic materials can be used for reconstruction of the structural deficits. Autogenous grafts from the septum, ear, rib, and calvarium are preferred for structural reconstruction, but surgeons should be well versed with alternative structural grafting materials. Smaller defects can be corrected through cartilaginous grafts, while larger defects require more rigid bony support to withstand the contractive forces of wound healing. Titanium mesh can serve as a viable alternative for rigid structural reconstruction. The ultimate goal of nasal reconstruction is to restore nasal form and function, and successful reconstruction starts with establishing a stable, functional, and anatomically sound osseocartilaginous framework.
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Hyaluronic Acid Fillers in Soft Tissue Regeneration
Facial plast Surg 2017; 33: 087-096
DOI: 10.1055/s-0036-1597685
Over the last years, hyaluronic acid (HA) injectable dermal fillers (DFs) have become the most popular agents for soft tissue contouring and volumizing. HA fillers are characterized by most of the properties that an ideal DF should have, due to HA unique chemical-physical properties, biocompatibility, biodegradability, and versatility. Therefore, HA DFs have revolutionized the filler market with a high number of products, which differ in terms of HA source, cross-linkage (agent and degree), HA concentration, hardness, cohesivity, consistency, inclusion or lack of anesthetic, indication, and longevity of correction. The article first provides a general introduction to DF world, and an overview of the different materials is available for fillers. Second, it describes the characteristics and the peculiarities of HA fillers, their differences from the other available materials, and therefore the reasons at the base of their success. Moreover, an update regarding the main Food and Drug Administration (FDA) approved fillers is presented.
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Nasal Reconstruction Involving Multiple Subunit Defects
Facial plast Surg 2017; 33: 058-066
DOI: 10.1055/s-0036-1597898
The challenges of nasal reconstruction are readily apparent to any surgeon who has undertaken this task. Defects involving multiple subunits of the nose usually require adjacent tissue transferred to the wound typically in the form of a forehead flap or other local flaps. Herein, we describe current thought on the subunit principle and the application of local flaps and grafts in reconstructing larger superficial defects of the nose. Primary attention is paid to analysis and patient counseling.
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Mandibular Rim Trilogy with Botulinum Toxin Injection: Reduction, Projection, and Lift
Facial plast Surg 2017; 33: 102-108
DOI: 10.1055/s-0037-1600525
"Onabotulinum toxin A (Botox) revolution" has brought the fundamental change in the facial rejuvenation as well as the concept of microinjection. The aesthetic standard tends to be the "globalization"; however, Asians have different aesthetic cultures and unique facial features compared with Caucasians. A new rejuvenation concept is proposed during our practice; the Asian face should preserve the original facial identity during Botox treatments. The lower face is treated with botulinum toxin to achieve a harmonious facial profile. Twenty young females ranging in age from 30 to 45 years consented and received the three-pronged procedure from March 2014 to April 2015; photography at baseline and follow-up visit were taken and analyzed. After posttreatment for 2 months, significant improvement was observed compared with the baseline. And the reduced masseter prominence and prominent chin were obtained, showing a favorable facial contour and harmonious appearance during the follow-up. The novel three-pronged approach to lower facial rejuvenation was aimed at the Asian characteristic of hypertrophic masseter, chin retrusion, and the facial sagging during the aging process. Botox treatment was a quite effective and safe strategy to improve the appearance and contour of the lower face in Asian patients.
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Reconstruction of the Intranasal Lining
Facial plast Surg 2017; 33: 067-073
DOI: 10.1055/s-0036-1597988
Reconstruction of full-thickness nasal defects has been the subject of surgical inquiry and innovation for over 2,000 years. The replacement of the internal nasal lining is a critical feature of complex nasal reconstruction. Successful reconstruction can prevent cicatricial contraction, external distortion, and internal stenosis. An array of reconstructive possibilities has been described, including cutaneous, mucosal, and fascial options. The challenge to the reconstructive surgeon is to select the repair that maximizes internal stability, while maintaining a patent nasal airway, minimizing morbidity, and meeting patient expectations. This article reviews the options available for the reconstruction of the intranasal lining.
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Titanium Mesh Nasal Repair without Nasal Lining
Facial plast Surg 2017; 33: 052-057
DOI: 10.1055/s-0036-1593747
The objective of this study was to describe outcomes for patients who underwent titanium mesh reconstruction of full-thickness nasal defects without internal lining repair. This is a retrospective cohort study. Patients with through-and-through nasal defects were identified at a single academic institution between 2008 and 2016. Nasal reconstruction was performed with either titanium mesh and external skin reconstruction without repair of the intranasal lining or traditional three-layer closure. Five patients underwent titanium mesh reconstruction and 11 underwent traditional three-layer repair. Median follow-up was 11 months (range, 2–66 months). The only significant difference between groups was older age in patients undergoing titanium reconstruction (mean, 81 vs. 63 years; difference of 18; 95% confidence interval [CI], 4–32 years). Defect extent including overall size and structures removed was similar between groups (p > 0.05). Paramedian forehead flap was the most common external reconstruction in both groups (100% for titanium mesh and 73% for three-layer closure). Time under anesthesia was significantly shorter for titanium mesh reconstruction (median, 119 vs. 314 minutes; difference of 195; 95% CI, 45–237). Estimated blood loss and length of hospital stay were similar between groups (p > 0.05). Complication rates were substantial although not significantly different, 40 and 36% in titanium and three-layer reconstruction, respectively (p > 0.05). All patients with complications after titanium reconstruction had prior or postoperative radiotherapy. Titanium mesh reconstruction of through-and-through nasal defects can successfully be performed without reconstruction of the intranasal lining, significantly decreasing operative times. This reconstructive technique may not be suitable for patients who undergo radiotherapy.
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Microvascular Flaps in Nasal Reconstruction
Facial plast Surg 2017; 33: 074-081
DOI: 10.1055/s-0036-1597984
Nasal reconstruction for subtotal and total rhinectomy defects is a challenging endeavor, which requires technical finesse, a keen artistic eye, and the ability to anticipate long-term changes that accompany postoperative healing. While local and regional flaps have traditionally been utilized to reconstitute missing nasal elements, certain situations may not provide sufficient or acceptable tissue for optimal reconstruction. In these situations, the three major components of the nose—lining, structural support, and external skin—may require reconstruction with tissues harvested from distant sites through microvascular free tissue transfer. Our objective in this article is to discuss the general approach to nasal reconstruction and present the considerations for free tissue transfer with regard to each nasal component. The virtues of free flap transfer as well as its shortcomings and potential complications are discussed.
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Novel Method for Obtaining Intraoperative Digital Video
Facial plast Surg 2017; 33: 114-115
DOI: 10.1055/s-0036-1597686
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Full text
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Recurrent Orbital Inflammation Due to Fibrous Dysplasia
Facial plast Surg 2017; 33: 112-113
DOI: 10.1055/s-0037-1598075
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Full text
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FOXO3, estrogen receptor alpha, and androgen receptor impact tumor growth rate and infiltration of dendritic cell subsets differentially between male and female mice
Abstract
Tumors evade immune recognition and destruction in many ways including the creation of an immune-suppressive tumor microenvironment (TME). Dendritic cells (DC) that infiltrate the TME are tolerogenic, and suppress effector T cells and anti-tumor activity. Previous reports demonstrated that a key regulator of tolerance in DC is the transcription factor FOXO3. Gender disparity has been studied in cancer in relation to incidence, aggressiveness, and prognosis. Few studies have touched on the importance in relation to impact on the immune system. In the current study, we show that there are significant differences in tumor growth between males and females. Additionally, frequencies and the function of FOXO3 expressed by DC subsets that infiltrate tumors vary between genders. Our results show for the first time that DC FOXO3 expression and function is altered in females. In vitro results indicate that these differences may be the result of exposure to estrogen. These differences may be critical considerations for the enhancement of immunotherapy for cancer.
http://ift.tt/2mbWlj3
Betel nut chewing, oral premalignant lesions, and the oral microbiome
by Brenda Y. Hernandez, Xuemei Zhu, Marc T. Goodman, Robert Gatewood, Paul Mendiola, Katrina Quinata, Yvette C. Paulino
Oral cancers are attributed to a number of causal agents including tobacco, alcohol, human papillomavirus (HPV), and areca (betel) nut. Although betel nut chewing has been established as an independent cause of oral cancer, the mechanisms of carcinogenesis are poorly understood. An investigation was undertaken to evaluate the influence of betel nut chewing on the oral microbiome and oral premalignant lesions. Study participants were recruited from a dental clinic in Guam. Structured interviews and oral examinations were performed. Oral swabbing and saliva samples were evaluated by 454 pyrosequencing of the V3- V5 region of the 16S rRNA bacterial gene and genotyped for HPV. One hundred twenty-two adults were enrolled including 64 current betel nut chewers, 37 former chewers, and 21 with no history of betel nut use. Oral premalignant lesions, including leukoplakia and submucous fibrosis, were observed in 10 chewers. Within-sample bacterial diversity was significantly lower in long-term (≥10 years) chewers vs. never chewers and in current chewers with oral lesions vs. individuals without lesions. Between-sample bacterial diversity based on Unifrac distances significantly differed by chewing status and oral lesion status. Current chewers had significantly elevated levels of Streptococcus infantis and higher and lower levels of distinct taxa of the Actinomyces and Streptococcus genera. Long-term chewers had reduced levels of Parascardovia and Streptococcus. Chewers with oral lesions had significantly elevated levels of Oribacterium, Actinomyces, and Streptococcus, including Streptococcus anginosus. In multivariate analyses, controlling for smoking, oral HPV, S.anginosus, and S. infantis levels, current betel nut chewing remained the only predictor of oral premalignant lesions. Our study provides evidence that betel nut chewing alters the oral bacterial microbiome including that of chewers who develop oral premalignant lesions. Nonetheless, whether microbial changes are involved in betel nut-induced oral carcinogenesis is only speculative. Further research is needed to discern the clinical significance of an altered oral microbiome and the mechanisms of oral cancer development in betel nut chewers.http://ift.tt/2lGyMku
Cancer prevalence, incidence and mortality in people who experience incarceration in Ontario, Canada: A population-based retrospective cohort study
by Fiona G. Kouyoumdjian, Lucie Pivnick, Kathryn E. McIsaac, Andrew S. Wilton, Aisha Lofters, Stephen W. Hwang
IntroductionEvidence suggests that many risk factors for cancer are overrepresented in people who experience incarceration, and data on cancer epidemiology are limited for this population. We aimed to describe cancer prevalence, incidence and mortality in adults admitted to provincial custody in Ontario, Canada in 2000.
MethodsWe linked data on 48,166 adults admitted to provincial custody in Ontario in 2000 with Ontario Cancer Registry data to 2012. We calculated cancer prevalence in the 10 years prior to admission to custody in 2000, incidence between 2000 and 2012 and mortality between 2000 and 2011. Standardized for age, we calculated incidence and mortality ratios by sex compared to the general population of Ontario.
ResultsThe 10-year cancer prevalence was 0.4% in men and 0.6% in women at admission to provincial custody in 2000. Between 2000 and 2012, 2.6% of men and 2.8% of women were diagnosed with new cancer. The standardized incidence ratio for cancer was 1.0 (95% CI 0.9–1.0) for men and 0.9 (95% CI 0.7–1.0) for women compared to the general population, and was significantly increased for cervical, head and neck, liver and lung cancers. The standardized mortality ratio was 1.6 (95% CI 1.4–1.7) in men and 1.4 (95% CI 1.0–1.9) in women, and was significantly increased for head and neck, liver, and lung cancers.
ConclusionsThere is an excess burden of cancer in people who experience incarceration. Cancer prevention should include people who experience incarceration, and the period of incarceration may offer an opportunity for intervention.
http://ift.tt/2lvWTQX
Dysregulation of interleukin 5 expression in familial eosinophilia
Abstract
Background
Familial eosinophilia (FE) is a rare autosomal dominant inherited disorder characterized by the presence of lifelong peripheral eosinophilia (>1500/μL). Mapped to chromosome 5q31-q33, the genetic cause of FE is unknown, and prior studies have failed to demonstrate a primary abnormality in the eosinophil lineage.
Objective
The aim of the present study was to identify the cells driving the eosinophilia in FE.
Methods
Microarray analysis and real-time PCR were used to examine transcriptional differences in peripheral blood mononuclear cells (PBMC), and in purified cell subsets from affected and unaffected family members belonging to a single large kindred. Cytokine levels in serum and PBMC culture supernatants were assessed by suspension array multiplexed immunoassays.
Results
Whereas IL5 mRNA expression was significantly increased in freshly isolated PBMC from affected family members, this was not accompanied by increased mRNA expression of other Th2 cytokines (IL4 or IL13). Serum levels of IL-5 and IL-5 receptor α, but not IgE, were similarly increased in affected family members. Of note, IL5 mRNA expression was significantly increased in purified CD3+ CD4+, CD14+, CD19+ and ILC2 cells from affected family members, as were IL-5 protein levels in supernatants from both stimulated PBMC and ILC2 cultures.
Conclusions
These data are consistent with the hypothesis that the eosinophilia in FE is secondary to dysregulation of IL-5 production in PBMC (and their component subsets).
This article is protected by copyright. All rights reserved.
http://ift.tt/2lHzVsf
Innate lymphoid cells in asthma: cannabinoids on the balance
Abstract
The network of cells and soluble mediators implicated in the pathogenesis of asthma and allergic disorders is complex. Deciphering details of the crosstalk between its components is essential for the identification of novel drug targets and for advances in patient management and precision medicine (1, 2). There is increasing evidence that innate lymphoid cells (ILCs) contribute to allergic responses (3).
This article is protected by copyright. All rights reserved.
http://ift.tt/2la9OXP
Natural evolution in patients with non-steroidal anti-inflammatory drugs -induced urticaria/angioedema
Abstract
Background
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent triggers of drug hypersensitivity with NSAIDs-induced urticaria/angioedema (NIUA) the most common phenotype. Loss of hypersensitivity has been reported for IgE-mediated reactions; however it has not been assessed in non-immunological reactions such as NIUA. We evaluated NSAID-hypersensitivity over time in NIUA patients.
Methods
Patients confirmed as NIUA by positive drug provocation test (DPT) with acetylsalicylic acid (ASA) during 2005-2012 (V1) were included (n=38). Subjects were prospectively reevaluated by DPT with ASA/other NSAIDs at two time points between 2013-2015 (V2 and V3). Atopy was assessed by skin prick test (SPT) using inhalant and food allergens.
Results
Patients were evaluated at V1 and reevaluated after 60 months (V2; IR:48-81) and a further 18 months (V3; IR:14-24). At V2, the majority (24; 63.15%) tolerated ASA and other NSAIDs (Group A) whilst 14 (36.84%) still reacted (Group B). At V3, all Group A patients remained tolerant; all Group B patients remained hypersensitive. The number of previous episodes reported at V1 and the percentage of reactions induced by ASA/ibuprofen were significantly lower in Group A (p=0.005 and p=0.006, respectively). Group A patients developed tolerance 72 months (IR:45-87) after their last evaluated reaction (V1); this interval was shorter in non-atopics (p=0.003), patients who experienced reactions over 1 hour after NSAIDs administration (p=0.001), and those who experienced isolated urticaria after NSAID intake (p=0.024).
Conclusions
NIUA patients may develop tolerance to NSAIDs over time, a process that seems to be influenced by atopy and type of clinical reaction.
This article is protected by copyright. All rights reserved.
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Incidence of elevated lipoprotein (a) levels in a large cohort of patients with cardiovascular disease
Abstract
Background
Recently it has been demonstrated that elevated lipoprotein (a) (LPA) levels are associated with an increased risk of cardiovascular disease across multiple ethnic groups. However, there is only scanty data about the incidence of elevated LPA levels in different patient cohorts. As a consequence, we aimed to examine whether patients with elevated LPA levels might be seen more often in a cardiovascular center in comparison to the general population.
Methods
We reviewed LPA concentrations of 52,898 consecutive patients who were admitted to our hospital between January 2004 and December 2014. We subdivided them into different groups according to their LPA levels. Data was compared to available information in medical literature.
Results
26.4% of the patients had LPA levels >30 mg/dl which is in line with the data from literature. Mean level of LPA concentration in our study was twice as high in comparison to the general population (25.8% vs. 13.3%). 4.6% had LPA levels >98 mg/dl (general population <0.3%).
Conclusion
In patients admitted to a cardiovascular center the proportion of LPA >30 mg/dl is comparable to the general population but mean levels over all are twice as high and the proportion of patients with LPA levels of >98 mg/dl is extremely higher.
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The efficacy and safety of sublingual immunotherapy in children and adult patients with allergic rhinitis
Source:Allergologia et Immunopathologia
Author(s): X. Lin, H. Lin, X. Wei, Q. Huang
BackgroundClinical research has shown that sublingual immunotherapy (SLIT) is effective and safe in moderate-severe allergic rhinitis (AR) induced by house dust mite (HDM). However, the sample size in many studies is small. Meanwhile, the controversy on the efficacy and safety in the very young children younger than four years old still existed.ObjectiveThe aim of this retrospective study is to evaluate the efficacy and safety of SLIT with Dermatophagoides farinae (Der.f) extracts in children and adult patients with allergic rhinitis, particularly in the very young children.MethodA total of 573 subjects aged 3–69 with AR received a three-year course of sublingual immunotherapy with Der.f extracts along with pharmacotherapy. The total nasal symptoms score (TNSS), total medication score (TMS), visual analogue score (VAS) and adverse events (AEs) were evaluated at each visit.ResultTNSS, TMS, VAS were significantly improved during the three-year course of treatment in comparison to the baseline values (P<0.01). Besides, significant improvement in nasal symptoms and reduction of medication use were also observed in young children aged 3–6 years (P<0.01). No severe systemic adverse events (AEs) were reported.ConclusionSLIT with Der.f drops is clinically effective and safe in children and adult patients with HDM-induced AR, including the very young children less than four years old.
http://ift.tt/2l9F9ti
Primary immunodeficiency diseases in Northern Iran
Source:Allergologia et Immunopathologia
Author(s): I. Mohammadzadeh, B. Moazzami, J. Ghaffari, A. Aghamohammadi, N. Rezaei
IntroductionPrimary immunodeficiency diseases (PID) are a heterogeneous group of inherited disorders, characterised by recurrent severe infections, autoimmunity and lymphoproliferation. Despite impressive progress in identification of novel PID, there is an unfortunate lack of awareness among physicians in identification of patients with PID, especially in non-capital cities of countries worldwide.ResultThis study was performed in a single-centre paediatric hospital in Northern Iran during a 21-year period (1994–2015). Ninety-four patients were included in this study. The majority of cases had antibody deficiencies (37.23%), followed by well-defined syndromes with immunodeficiency in 16 (17.02%), phagocytic disorders in 15 patients (15.95%), complement deficiencies in 15 patients (15.95%), immunodeficiencies affecting cellular and humoral immunity in nine patients (9.57%), disease of immune dysregulation in three (3.19%), and defects in intrinsic and innate immunity in one (1.06%).ConclusionIt seems that there are major variations in frequency of different types of PID in different regions of a country. Therefore, reporting local data could provide better ideas to improve the local health care system strategists and quality of care of PID patients.
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Prenatal paracetamol use and asthma in childhood: A systematic review and meta-analysis
Source:Allergologia et Immunopathologia
Author(s): G. Fan, B. Wang, C. Liu, D. Li
ObjectivesSome studies have suggested that prenatal paracetamol exposure might associate with the risk of child asthma. However, other studies have not confirmed this result. Therefore, we conducted a meta-analysis to investigate their relationship.MethodsTwo authors searched Pubmed and Embase databases up to June 2016. The strength of the association was calculated with the OR and respective 95% CIs. The random-effects model was chosen to calculate the pooled OR.ResultsA total of 13 articles of more than 1,043,109 individuals were included in the meta-analysis. A statistically significant association between prenatal paracetamol exposure and child asthma risk was found. The data showed that prenatal paracetamol exposure could increase the risk of child asthma (OR=1.19; 95% CI, 1.12–1.27; P<0.00001) in a random-effect model. Six studies reported paracetamol exposure during the first trimester of pregnancy. We found that paracetamol exposure during the first trimester of pregnancy was associated with increased risk of child asthma (OR=1.21; 95% CI, 1.14–1.28; P<0.00001). Furthermore, we observed that paracetamol exposure during the 2–3 trimesters of pregnancy was also associated with child asthma risk (OR=1.13; 95% CI, 1.04–1.23; P=0.005).ConclusionsThis study suggested that prenatal paracetamol exposure was significantly associated with the increased risk of child asthma.
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Low dose treatment of mice with bacterial extract (OM-85) for attenuation of experimental atopic asthma in mice
Source:Allergologia et Immunopathologia
Author(s): P.G. Holt, D.H. Strickland
http://ift.tt/2lGODiW
The role of active B cells in allergen immunotherapy
Publication date: Available online 21 February 2017
Source:Allergologia et Immunopathologia
Author(s): M.H. Celiksoy, R. Sancak, A. Yildiran
BackgroundThe purpose of this study is to examine the changes in B lymphocyte subsets in patients receiving allergen immunotherapy.MethodsB lymphocyte subsets of patients before immunotherapy and one year after immunotherapy began were examined using the flow cytometric method. Age-matched healthy children served as the control group.ResultsTwenty-two patients with asthma and/or allergic rhinitis and 14 healthy, age-matched controls were included in the study. The median age of the patients was 13 years old (range: 6–20 years), and eleven (50.0%) were male. The median age of the healthy controls was also 13 years old (range: 7–17), and seven (50.0%) were male. In the age group from 11 to 15 years; the patients' relative and absolute counts of active and mature sensitive B cells were higher than those of the healthy children (p=0.027–0.012 and p=0.032–0.010, respectively) before immunotherapy. The relative and absolute counts of active B cells before immunotherapy were also significantly higher than those of after immunotherapy (p=0.001–0.001, p=0.025–0.037, and p=0.029–0.035, respectively). Before immunotherapy, the relative and absolute counts of mature sensitive B cells were significantly higher than those obtained after immunotherapy (p=0.024–0.006) in the 11–15-year-old age group.ConclusionsAllergen immunotherapy directly influences B cell differentiation and causes a decrease in the count of active B cells. This finding is relevant because the B cell count can be used as a guide in the assessment of an individual patient's treatment response and also when determining whether to continue the immunotherapy.
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Immune response of toddlers with history of prematurity
Publication date: Available online 21 February 2017
Source:Allergologia et Immunopathologia
Author(s): S.P. Muraro, P.M. Pitrez, A.P.D. de Souza, B.N. Porto, J.E. Vargas, I.P. Ewald, J.P. Heinzmann-Filho, G. dos Santos, T.S. Baptista, T.D. Gandolfi, F.D. Machado, M.H. Jones, C. Bonorino, R.T. Stein
BackgroundIt is not quite well established how immune responses differ in term and preterm infants beyond the first year of life. This study aimed to evaluate aspects of the innate and adaptive immune responses in a group of preterm infants in comparison with their term peers.MethodsIn this cross-sectional study peripheral blood mononuclear cells (PBMC) were isolated from preterm and term children at age three years. Innate immune response was evaluated by the analysis of TLR receptors expression on CD11c+HLADRhigh cells and inflammatory cytokine production after PBMC stimulation with Toll like receptors (TLR) ligands. Adaptive immune response was evaluated by T cells' phenotyping and function after stimulation with polyclonal conventional T cell stimulus.ConclusionWe have found that the patterns of innate and adaptive immune responses at 3 years of age were not affected by the fact of the children having being born preterm or at term.
http://ift.tt/2lGUXqU
A critical review on serine protease: Key immune manipulator and pathology mediator
Publication date: Available online 21 February 2017
Source:Allergologia et Immunopathologia
Author(s): S. Patel
Proteolytic activity is fundamental to survival, so it is not surprising that all living organisms have proteases, especially seine protease. This enzyme in its numerous isoforms and homologues, constitutes the quintessential offence and defence factors, in the form of surface proteins, secreted molecules, gut digestive enzymes, venom in specialised glands or plant latex, among other manifestations. Occurring as trypsin, chymotrypsin, elastase, collagenase, thrombin, subtilisin etc., it mediates a diverse array of functions, including pathological roles as inflammatory, coagulatory to haemorrhagic. This review emphasizes that despite the superficial differences in mechanisms, most health issues, be they infectious, allergic, metabolic, or neural have a common conduit. This enzyme, in its various glycosylated forms leads to signal misinterpretations, wreaking havoc. However, organisms are endowed with serine protease inhibitors which might restrain this ubiquitous yet deleterious enzyme. Hence, serine proteases-driven pathogenesis and antagonising role of inhibitors is the focal point of this critical review.
http://ift.tt/2l9zweT
Recurring septic shock in a patient with blunt abdominal and pelvic trauma: how mandatory is source control surgery?: a case report
In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different...
http://ift.tt/2kNqQP5
The Evolution of Endoscopic Intracranial Surgeries
Abstract
Purpose of Review
The challenging surgical field of endoscopic skull base surgery has undergone tremendous advancement in the past years. The aim of this review was to discuss the important factors that contributed to the evolution of this exciting field.
Recent Findings
Endoscopic skull base surgery started with pituitary surgeries and closure of cerebrospinal fluid (CSF) leaks. As the field progresses, it is now possible to operate on selected lesions located in areas ranging from the cribriform plate down to the second cervical vertebra and laterally to the infratemporal fossa and petrous apex. The key factors that contributed to the evolution of endoscopic intracranial surgeries include the development of modern endoscopy equipment, advancement of endoscopic anatomy knowledge, and improvement in skills to perform endoscopic surgical resection, reconstruction, and hemostasis.
Summary
Extended endonasal approaches can provide skull base surgeons with safe and effective access to the anterior, middle, and posterior cranial fossae in selected cases.
http://ift.tt/2lMojEz
Image Guidance in Endoscopic Sinus Surgery: Where Are We Heading?
Abstract
Purpose
The purpose of this review is to identify new developments in image guided surgery (IGS) for endoscopic sinus surgery (ESS), with a focus on how these innovations will serve to aid the endoscopic sinus surgeon.
Findings
Several developments in both the software and hardware of IGS systems have been introduced or are under development. These include augmented reality and three-dimensional (3D) virtual endoscopy for integrating navigational and endoscopic images. Intraoperative registration can further improve the accuracy within a given operative field. Wireless instrumentation and consolidated IGS workstations can improve operating room logistics. IGS integrated robotic surgery can enhance surgical precision and automate critical portions of the procedure. Emerging evidence suggests that IGS is useful for the avoidance of complications in ESS and improving surgeon workload.
Summary
Numerous developments in IGS for ESS will serve to aid the endoscopic sinus surgeon in avoiding complications and improving patient outcomes.
http://ift.tt/2l0F5LS
Acquired prolongation of QT interval as a risk factor for torsade de pointes ventricular tachycardia: a narrative review for the anesthesiologist and intensivist
Abstract
More than 70% of intensive care unit (ICU) patients experience heart rhythm disturbances, and these patients have correspondingly higher mortality rates. Consequently, one of the standards of care in ICUs is continuous electrocardiography monitoring. One of the potentially preventable dysrhythmic events is the occurrence of torsade de pointes ventricular tachycardia in the setting of acquired prolonged QT interval. This type of ventricular tachycardia can be malignant because it often progresses to ventricular fibrillation. Many factors predispose to lengthening of the QT interval, the most important of which are electrolyte abnormalities and the administration of specific medications. In this review, we discuss the pathophysiology of acquired long QT interval, stressing the medication-induced acquired long QT-interval and factors present in ICU patients that promote prolongation of the QT interval. We also propose guidelines to avoid the occurrence of torsade de pointes ventricular tachycardia.
http://ift.tt/2mmjb6A
Premolar autotransplantation in juvenile dentition: Quantitative assessment of vertical bone and soft tissue growth
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Inessa Michl, Dirk Nolte, Claudia Tschammler, Martin Kunkel, Robert Linsenmann, Johannes Angermair
ObjectivePremolar autotransplantation represents an effective therapeutic option for the treatment of juvenile dentition with either aquired or congenital hypodontia. The objective of this prospective clinical study was to quantitatively assess bone and soft tissue levels after autogenous premolar transplantation by clinical and radiographic parameters.Study DesignIn the study 26 premolars were transplanted in 20 patients after traumatic tooth loss (n=16) or congenital aplasia (n=10) in the anterior maxilla. Based on standardized photographic documentation, the relative soft tissue level was measured in comparison to the healthy adjacent teeth. Radiographic findings included the evaluation of root resorption, pulp canal obliterations and the relative bone height.ResultsAverage survival rate of transplanted premolars (n = 26) was 100% over a follow-up period of 29 months (range 10-60 months). The relative soft tissue level significantly increased by +1.1 mm (p<0.05). Radiographs showed the tendency to vertical bone growth. Continuous root development and signs of pulpal healing were observed postoperatively on 18 transplants (69.2%).ConclusionsAutogenous premolar transplantation represents a safe method to ensure functional and aesthetic rehabilitation in the anterior maxilla irrespective of the nature of tooth loss. ClinicalTrials.gov: NCT02740907
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Case of a cerebral abscess caused by Porphyromonas gingivalis in a subject with periodontitis
We report the case of a 65-year-old man presenting with generalised seizures after developing a right frontal brain abscess. Stereotactic aspiration and subsequent matrix assisted laser desorption/ionisation time-of-flight analyzer (MALDI-TOF) spectrometry revealed Porphyromonas gingivalis as the only causative anaerobe microorganism. Secondary incision and drainage was required due to neurological deterioration with increased dimensions of the abscess, intracranial pressure and formation of a subdural occipitoparietal empyema. Oral imaging was positive for apical periodontitis of multiple elements; therefore, the remaining dentition was removed. Targeted antibiotic treatment included intravenous ceftriaxone and ornidazole. The patient was discharged to our revalidation unit 59 days after admission to make a full recovery. To the best of our knowledge, this is the sixth reported case of P. gingivalis causing an intracranial abscess and the third case of a true intracerebral parenchymal abscess caused by this bacterium.
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Vertebral B-cell lymphoma mimicking a Pott's disease in a man aged 63 years coming back from Tunisia
Description
We report the case of a man aged 63 years, a native from Tunisia, whose medical history was marked by diabetes treated with insulin (complicated with inferior limbs polyneuropathy), an ischaemic heart disease, a peripheral arterial disease and a smoking-related chronic obstructive pulmonary disease. His mother might have had pulmonary tuberculosis. He was retired since 2 years and shared his life between Tunisia and France. He had mechanical back pain since several years, but since 3 months, his back pain awakened him at night and was accompanied with loss of weight and anorexia. There was no fever or night sweats. In Tunisia, he underwent a CT scan showing a retroperitoneal mass infiltrating the left psoas and the left renal artery close to the aorta with the erosion of the L2 cortical and spondylitis (figure 1A, B). There was also regional necrotic lymphadenopathy. The patient decided to return...
http://ift.tt/2lpL7ZO
Two faces of gamma-delta mycosis fungoides: before and after renal transplantation
We describe a patient with a 30-year history of mycosis fungoides (MF) and renal transplantation performed 3 years before he presented with an ulcerated tumour in the lumbosacral area. Biopsy revealed a lymphatic infiltrate of medium-sized, pleomorphic T cells expressing the gamma–delta T-cell receptor. Radiological staging and bone marrow biopsy revealed no extracutaneous involvement. Despite reduction in systemic immunosuppressants, total skin electron beam radiotherapy and systemic chemotherapy, the disease followed a highly aggressive course and the patient died 31 years after initial diagnosis of MF. Pre-existing MF is not listed as a contraindication for solid organ transplantation. With an ever-increasing number of organ recipients, the number of MF patients undergoing solid organ transplantation will be likely to increase. Systematic collection and analysis of such cases is thus warranted to lead to a better understanding to what kind MF gets influenced by solid organ transplantation and ongoing immunosuppression.
http://ift.tt/2l0wJnt
Crohn's disease complicated by Epstein-Barr virus-driven haemophagocytic lymphohistiocytosis successfully treated with rituximab
We report a case of Epstein-Barr virus (EBV)-driven haemophagocytic lymphohistiocytosis (HLH) in a man with Crohn's disease treated with 6-mercaptopurine and adalimumab therapy who was successfully treated with rituximab therapy alone. This is the first published case in an adult patient with EBV-driven HLH in the setting of thiopurine use and inflammatory bowel disease to be successfully treated with rituximab therapy alone. Here, we will discuss putative immunological mechanisms which may contribute to this potentially life-threatening complication.
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Atypical case of preterm ovarian hyperstimulation syndrome
Preterm ovarian hyperstimulation syndrome is a rare syndrome in which preterm infant girls have hypogastric, upper leg and labial swelling accompanied by elevated serum oestradiol levels and ovarian follicular cysts on ultrasound. Our case is an infant born at 23 weeks gestational age who at 30 weeks postconceptional age (PCA) developed elevated 17-hydroxyprogesterone on her newborn screen with associated clitoromegaly and a ventral groove on the inferior aspect of the erectile tissue. An initial pelvic ultrasound at 32 weeks PCA demonstrated a normal appearing uterus, but the ovaries were not visualised. At 39 weeks PCA, follicular ovarian cysts were noted bilaterally (31x26x21 mm on left and 38x25x36 mm on right). Without treatment, oestradiol and testosterone levels began normalising by 42 weeks PCA. After this point, the right ovarian cysts had resolved and the left ovarian cyst continued to diminish in size.
http://ift.tt/2l0waK5
Case of primary bilateral diffuse large B-cell lymphoma of the ovary with plasmablastic features in an HIV-negative female patient
A 37-year-old woman from Puerto Rico presented to our clinic with symptoms of an abdominal distension progressively worsening over 1 year. A CT of an abdomen and pelvis with contrast was performed and revealed bilateral large heterogeneous pelvic adnexal masses with large ascites and right pleural effusion. Tumour markers CA 125 was 766 U/mL and lactate dehydrogenase was 654 U/L. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection and partial omentectomy. Pathology of ovarian masses revealed a diffuse large B-cell lymphoma. The staging work-up was negative, which pointed towards the diagnosis of primary ovarian lymphoma. The patient completed 8 cycles of cyclophosphamide, doxorubicin, vincristine, prednisolone chemotherapy. After 18 months of chemotherapy completion, she remains in remission.
http://ift.tt/2lpN1ty
Right upper quadrant abdominal pain as the initial presentation of polyarteritis nodosa
Polyarteritis nodosa (PAN) is a necrotising vasculitis that involves medium and small vessels. PAN generally presents with constitutional, cutaneous, neurological, renal and gastrointestinal manifestations. However, PAN initially involving a single organ/system is uncommon. Here, we present a 42-year-old man who was hospitalised because of severe right upper quadrant abdominal pain that started 2 months before. Physical examination was remarkable for right upper quadrant abdominal tenderness. Abdominopelvic CT showed lymphadenopathy but no hepatic, gallbladder, pancreatic, intestinal or renal abnormalities. Abdominal angiography showed multiple small aneurysms located in the jejunal and hepatic arteries characteristic of PAN. He had a prompt and remarkable response to high-dose corticosteroids and oral cyclophosphamide. Our case, together with other reports, suggests that PAN should be considered in patients presenting with right upper abdominal pain. Timely diagnosis and treatment reduce the overall morbidity and mortality of the disease.
http://ift.tt/2l0pwUm
Term neonate with pneumopericardium, pneumothorax while on nasal continuous positive airway pressure (nCPAP)
Description
This baby girl was born at 37 weeks to a woman aged 30 years. Her birth weight was 2.99 kg. The antenatal period was uneventful with no risk factors for infection or any other high-risk conditions. The baby was born by normal vaginal delivery and required no active resuscitation at birth. Within a few minutes after birth, the baby developed respiratory distress, and hence was started on nasal continuous positive airway pressure, with pressure of 6 and FiO2 of 0.21. Auscultation revealed diminished air entry on the left side of the chest as well as muffled heart sound. Chest X-ray showed a pneumopericardium and left pneumothorax (figures 1 and 2). As there was no X-ray prior to starting CPAP, it was not possible to determine whether the air leaks were present before or initiation of the CPAP contributed to that development. Fortunately, the baby did not...
http://ift.tt/2lpJ4oo
Triamcinolone emboli leading to central retinal artery occlusion: a multimodal imaging study
A 19-year-old man presented with unilateral sudden onset vision loss following an intra-articular triamcinolone injection in the right temporomandibular joint. At fundus examination emboli of triamcinolone were visible in multiple retinal arteries. Choroidal ischaemia and occlusion of the central retinal artery and its branches were documented at fluorescein angiography. Optical coherence tomography revealed significant thickening of the inner retinal layers. Optical coherence tomography angiography clearly demonstrated an abrupt cut-off of flow in a vessel below the optic disc. Lack of perfusion of the superficial and deep retinal plexuses beyond the areas of embolisation and at the posterior pole was also appreciated. The visual outcome was poor despite treatment.
http://ift.tt/2l0x0H5
Sagittal sinus thrombosis in JAK2-V617F mutation without overt myeloproliferative disorder
We describe a case of a man aged 41 years who presented with a history of generalised headaches for 1 week and an acute episode of tonic–clonic seizures. He had no history of medical illness, was non-smoker, with an extensive family history of haematological disorders. Initial CT brain with contrast did not show any abnormalities in brain parenchyma. X-ray and CT right shoulder showed shoulder dislocation secondary to trauma associated with seizure prior to hospital admission. Subsequently, MRA and MRV brain was arranged, which revealed extensive expansible occlusive filling defect dominating the middle of superior sagittal sinus with left frontal cortical and subcortical acute oedema. He was promptly started on anticoagulation therapy. Considering the unusual site and unprovoked nature of thrombosis, further investigations including JAK2 mutation were arranged which revealed latent myeloproliferative disorder. He was referred to haematology services for further follow-up and monitoring of latent myeloproliferative disorder.
http://ift.tt/2lpNKuP
A case of paradoxical presentation of a postural postdural puncture headache after combined spinal-epidural anesthesia
We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position.
http://ift.tt/2l8HqoM
Mohs Micrographic Surgery vs Wide Local Excision for Melanoma In Situ
This cohort study assesses the outcomes of melanomas in situ treated with Mohs micrographic surgery compared with those treated with wide local excision.
http://ift.tt/2l8Ajg8
http://ift.tt/2l8Ajg8
Secukinumab for the Treatment of DITRA in an Adolescent
This case report describes the use of secukinumab for the treatment of deficiency of interleukin 36 receptor antagonist in an adolescent.
http://ift.tt/2lGeJmp
http://ift.tt/2lGeJmp
Clinical Image Guidelines for Documentation of Skin-Related Conditions
This Consensus Statement provides guidelines for the clinical application of the Standards for Dermatological Imaging set forward by the International Skin Imaging Collaboration.
http://ift.tt/2l8RON8
http://ift.tt/2l8RON8
Main Characteristics of Zika Virus Exanthema
This study reports on the clinical characteristics of the Zika virus in Guadeloupean adults and children with confirmed cases.
http://ift.tt/2lGd1kN
http://ift.tt/2lGd1kN
Next-Generation Sequencing in HHV-8–Negative Castleman Disease
Castleman disease (CD) comprises a heterogeneous group of lymphoproliferative disorders that share similar histopathological lymph node changes. They are separated into unicentric CD (UCD), which is characterized by lymph node enlargement localized to 1 nodal region and few to no systemic symptoms, or multicentric CD (MCD), which is characterized by generalized lymphadenopathy and often systemic symptoms. Multicentric CD can be further subdivided into human herpesvirus 8 (HHV-8)-positive and HHV-8–negative MCD (or idiopathic MCD). In this issue of JAMA Dermatology, Patel et al documented a very elegant use of next-generation sequencing to explain the dramatic response to therapy in a very rare, cutaneous-only manifestation of CD and, by doing so, have provided important therapeutic and future study–design guidance for patients with CD.
http://ift.tt/2l8OQZ9
http://ift.tt/2l8OQZ9
JAK1 Genomic Alteration and Response to Siltuximab in Castleman Disease
This case report investigates and identifies molecular aberrations to help explain the exceptional response to siltuximab in a patient with cutaneous Castleman disease.
http://ift.tt/2lGjD2t
http://ift.tt/2lGjD2t
Contact Allergy in Children With Atopic Dermatitis
This study uses data from the Pediatric Contact Dermatitis Registry to examine the associations and sensitizations among patients with concomitant atopic dermatitis and allergic contact dermatitis.
http://ift.tt/2l8YJWH
http://ift.tt/2l8YJWH
The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study
Publication date: Available online 22 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Hanifi Kurtaran, K. Serife Ugur, Ceyda Sel Yilmaz, Mesut Kaya, Alper Yuksel, Nebil Ark, Mehmet Gunduz
IntroductionNasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing.ObjectiveThe aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency.MethodsThe present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with Xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10cm Visual Analog Scale (VAS). In addition, patients were examined to determine the crusting score.ResultsThere was no significant difference found in the preoperative and 7th and 15th postoperative days' Mucociliary Clearance Times (MCT) among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p<0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p<0.001).ConclusionHypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.
http://ift.tt/2lGhLXv
Influence of dietary and physical activity restriction on pediatric adenotonsillectomy postoperative care in Brazil: a randomized clinical trial
Publication date: Available online 22 February 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Denise Manica, Leo Sekine, Larissa S. Abreu, Michelle Manzini, Luísi Rabaioli, Marcel M. Valério, Manoela P. Oliveira, João A. Bergamaschi, Luciano A. Fernandes, Gabriel Kuhl, Cláudia Schweiger
IntroductionAlthough culturally food and physical activity restriction are part of the routine postoperative care of many Brazilian surgeons, current evidences from other countries support no such recommendations.ObjectiveTo determine whether dietary and physical restriction effectively lead to a decrease on postoperative complications of adenotonsillectomy in children when compared to no restriction.MethodsWe have designed a randomized clinical trial comparing two intervention: no specific counseling on diet or activity (Group A), and restriction recommendations on diet and physical activities (Group B). Caregivers completed a questionnaire on observed pain, diet and activity patterns, and medications administered. Parameters were compared at the 3rd and at the 7th postoperative day between intervention groups.ResultsWe have enrolled a total of 95 patients, 50 in Group A and 45 in Group B. Fourteen patients were lost to follow up. Eventually, 41 patients in group A and 40 in Group B were available for final analysis. Mean age in months (A=79.5; SD=33.9/B=81.1; SD=32.6) and sex (A=58% male; B=64.4% male) were equivalent between groups. Pain, evaluated through visual analog scale in the 3rd (A=2.0; IQR 1–6/B=4.5; IQR 2–6; p=0.18) and in the 7th (A=1.0; IQR 1.0–4.5/B=2.0; IQR 1.0–4.7; p=0.29) postoperative days, was not different between groups, as was the amount of analgesics administered. Dietary and physical activity patterns also showed no statistically significant differences between groups.ConclusionDietary and activity restriction after adenotonsillectomy does not seem to affect patients' recovery. Such information may impact considerably on the social aspects that involve a tonsillectomy, reducing the working days lost by parents and accelerating the return of children to school.
http://ift.tt/2l8Sa6H
Cutaneous adnexal adenocarcinoma with exquisite sensitivity to trastuzumab
ABSTRACT
Background
Cutaneous adnexal adenocarcinoma is a rare cancer that is occasionally human epidermal growth factor receptor-2 (HER-2)-positive, and demonstrates variable response to HER-2 inhibitors.
Methods
We report a case of adnexal adenocarcinoma of the scalp in a 56-year-old man. He underwent wide local excision with cervical node dissection followed by radiation, but had extensive local recurrence.
Results
Pathology demonstrated a poorly differentiated adnexal adenocarcinoma with HER-2 overexpression by immunohistochemistry (IHC) and high HER-2 gene amplification by fluorescence in situ hybridization. The patient was treated with trastuzumab-based therapy with dramatic response and clinical resolution of the tumor. Upon pausing trastuzumab, he developed local relapse, but had an excellent response to restarting trastuzumab monotherapy. He lacks visible disease 43 months after the initial diagnosis.
Conclusion
We believe the exquisite sensitivity of the primary carcinoma and subsequent recurrence to trastuzumab therapy was due to strong HER-2 expression both at the protein and gene level. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
http://ift.tt/2mcaXPk
Potential clinical significance of perioperative levels of mRNA in plasma from patients with cancer of the larynx or hypopharynx
Abstract
Background
The use of plasma as a "liquid biopsy" has gained increasing attention. The purpose of the present study was to evaluate the diagnostic and prognostic utility of the perioperative detection and quantitation of mRNAs encoding human telomerase reverse transcriptase (hTERT) and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) in plasma from patients with cancer of the larynx or hypopharynx.
Methods
We recruited 47 patients with laryngeal cancer and 2 patients with hypopharyngeal cancer, plus 27 healthy subjects. A blood sample was taken from each patient before and after surgical resection of the tumor. We quantified hTERT mRNA and GAPDH mRNA in plasma by real-time polymerase chain reaction (PCR).
Results
Detection of hTERT mRNA before surgery had diagnostic value (sensitivity, 22%; specificity, 100%). Detection was more frequent in patients with supraglottic tumors than glottic tumors (p = .02) and was related to subsequent recurrence (p = .02). Preoperative levels of hTERT mRNA in plasma were higher in patients with subsequent recurrence (p = .046) and/or metastases (p = .047). The disease-free survival (DFS) and overall survival (OS) of patients with plasma samples positive for hTERT mRNA was poorer than that of patients with negative samples. Mean levels of plasma GAPDH mRNA in untreated patients were higher than in healthy subjects (p < .001).
Conclusion
Detection and quantitation of hTERT and GAPDH mRNA in patients' plasma might be clinically significant in cases of laryngeal and hypopharyngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
http://ift.tt/2loRug5
Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes
ABSTRACT
Background
The purpose of this study was to present our evaluation of a new speech pathology telepractice service supporting the swallowing and communication management of patients with head and neck cancer.
Methods
A multicenter randomized controlled trial was conducted within a large public cancer service. Referrals from speech pathologists at 3 regional sites (spoke sites) were managed by a specialist clinician from a cancer center (hub site) either via standard care (phone/email support/appointments at the hub site) or a newly established telepractice service (online consultation between the hub site and spoke site).
Results
Eighty-two referrals (39 for standard care and 43 for telepractice care) were managed. Service efficiency favoring the telepractice model was reported with a significant reduction in the number (p = .004) and duration (p = .024) of contact events required to manage the referrals. Higher consumer and clinician satisfaction was also reported for the telepractice service.
Conclusion
A speech pathology telepractice service benefits both the patient and health provider through higher service efficiency and treatment satisfaction. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
http://ift.tt/2mcaWuK
The Hippo component YAP localizes in the nucleus of human papilloma virus positive oropharyngeal squamous cell carcinoma
HPV infection causes cervical cancer, mediated in part by the degradation of Scribble via the HPV E6 oncoprotein. Recently, Scribble has been shown to be an important regulator of the Hippo signaling cascade. ...
http://ift.tt/2mbpBq8
Nutritional Wheat Amylase-Trypsin Inhibitors Promote Intestinal Inflammation via Activation of Myeloid Cells
Publication date: Available online 16 December 2016
Source:Gastroenterology
Author(s): Victor F. Zevallos, Verena Raker, Stefan Tenzer, Carolina Jimenez-Calvente, Muhammad Ashfaq-Khan, Nina Rüssel, Geethanjali Pickert, Hansjörg Schild, Kerstin Steinbrink, Detlef Schuppan
Background & AimsWheat amylase-trypsin inhibitors (ATIs) are nutritional activators of innate immunity, via activation of the toll-like receptor 4 (TLR4) on myeloid cells. We aimed to characterize the biologic activity of ATIs in various foods and their effect on intestinal inflammation.MethodsWe selected 38 different gluten-containing and gluten-free products, either unprocessed (such as wheat, rye, barley, quinoa, amaranth, soya, lentils, and rice) or processed (such as pizza, pasta, bread, and biscuits). ATIs were extracted and their biological activities determined in TLR4-responsive mouse and human cell lines. Effects of oral ATIs on intestinal inflammation were determined in healthy C57BL/6 mice on a gluten-free or ATI-free diet and in mice given low-level polyinosinic:polycytidylic acid or dextran sodium sulfate to induce colitis. Parameters of innate and adaptive immune activation were determined in duodenum, ileum, colon, and mesenteric lymph nodes.ResultsModern gluten-containing staples had levels of TLR4-activating ATIs that were as much as 100-fold higher than in most gluten-free foods. Processed or baked foods retained ATI bioactivity. Most older wheat variants (such as Emmer or Einkorn) had lower bioactivity than modern (hexaploid) wheat. ATI species CM3 and 0.19 were the most prevalent activators of TLR4 in modern wheat and were highly resistant to intestinal proteolysis. Their ingestion induced modest intestinal myeloid cell infiltration and activation, and release of inflammatory mediators—mostly in the colon, then in the ileum, and then in the duodenum. Dendritic cells became prominently activated in mesenteric lymph nodes. Concentrations of ATIs found in a normal daily gluten-containing diet increased low-level intestinal inflammation.ConclusionsGluten-containing cereals have by far the highest concentrations of ATIs that activate TLR4. Orally ingested ATIs are largely resistant to proteases and heat, and increase intestinal inflammation by activating gut and mesenteric lymph node myeloid cells.
http://ift.tt/2mbqUFn
Preventive effects of topical washing with miconazole nitrate-containing soap to diaper candidiasis in hospitalized elderly patients: A prospective, double-blind, placebo-controlled study
Abstract
The objective of the present randomized, double-blind trial was to evaluate the efficacy and safety of daily washing with miconazole nitrate-containing soap for candidiasis at diaper-covered sites in elderly subjects under long-term inpatient care. To confirm the onset and disappearance of candidiasis, we microscopically evaluated the existence of the pseudohyphae and/or blastoconidia of Candida spp. We enrolled 75 elderly patients who wore diapers all day in the hospital or nursing home. Patients were randomly assigned to receive treatment with either miconazole soap or miconazole-free placebo soap, and 28 patients in the miconazole group and 27 patients in the placebo group were followed for 4 weeks. Although washing with miconazole soap did not affect the frequency of pseudohyphae/blastoconidia-positive patients, it significantly inhibited the positive conversion of pseudohyphae/blastoconidia compared with the placebo group. As a result, the frequency of patients positive for pseudohyphae/blastoconidia was significantly lower in the miconazole group than in the control group at 4 weeks (17.9% vs 44.4%). Clinically apparent diaper candidiasis did not develop in either group. Washing with miconazole soap was a significant independent factor for reducing the cases positive for pseudohyphae/blastoconidia, while diarrhea and heart failure were significant factors associated with an increase in the positive rate at the end-point. Severe adverse effects were not found in any patients. Thus, washing with miconazole soap is well-tolerated and can inhibit the positive conversion of Candida in patients wearing diapers. Therefore, maintenance of genital hygiene using this soap may prophylactically decrease the overall prevalence of patients with diaper candidiasis.
http://ift.tt/2lnoJ3m
Treatment with grass allergen peptides improves symptoms of grass pollen–induced allergic rhinoconjunctivitis
Publication date: Available online 21 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Anne K. Ellis, Charles W. Frankish, Robyn E. O'Hehir, Kristen Armstrong, Lisa Steacy, Mark Larché, Roderick P. Hafner
BackgroundSynthetic peptide immunoregulatory epitopes are a new class of immunotherapy to treat allergic rhinoconjunctivitis (ARC). Grass allergen peptides, comprising 7 synthetic T-cell epitopes derived from Cyn d 1, Lol p 5, Dac g 5, Hol l 5, and Phl p 5, is investigated for treatment of grass pollen–induced ARC.ObjectiveWe sought to evaluate the efficacy, safety, and tolerability of intradermally administered grass allergen peptides.MethodsA multicenter, randomized, double-blind, placebo-controlled study evaluated 3 regimens of grass allergen peptides versus placebo in patients with grass pollen–induced allergy (18-65 years). After a 4-day baseline challenge to rye grass in the environmental exposure unit (EEU), subjects were randomized to receive grass allergen peptides at 6 nmol at 2-week intervals for a total of 8 doses (8x6Q2W), grass allergen peptides at 12 nmol at 4-week intervals for a total of 4 doses (4x12Q4W), or grass allergen peptides at 12 nmol at 2-week intervals for a total of 8 doses (8x12Q2W) or placebo and treated before the grass pollen season. The primary efficacy end point was change from baseline in total rhinoconjunctivitis symptom score across days 2 to 4 of a 4-day posttreatment challenge (PTC) in the EEU after the grass pollen season. Secondary efficacy end points and safety were also assessed.ResultsTwo hundred eighty-two subjects were randomized. Significantly greater improvement (reduction of total rhinoconjunctivitis symptom score from baseline to PTC) occurred across days 2 to 4 with grass allergen peptide 8x6Q2W versus placebo (−5.4 vs −3.8, respectively; P = .0346). Greater improvement at PTC also occurred for grass allergen peptide 8x6Q2W versus placebo (P = .0403) in patients with more symptomatic ARC. No safety signals were detected.ConclusionGrass allergen peptide 8x6Q2W significantly improved ARC symptoms after rye grass allergen challenge in an EEU with an acceptable safety profile.
http://ift.tt/2lKZwRd
The impact on quality of life on families of children on an elimination diet for Non-immunoglobulin E mediated gastrointestinal food allergies
The impact on health related quality of life (HRQL) has been well studied in children with Immunoglobulin E (IgE)-mediated food allergy. However limited data exists on related quality of life (QOL) of families...
http://ift.tt/2l6M5Ym
A New Application of the Bioarchaeology of Care Approach: A Case Study from the Metal Period, Philippines
Abstract
A case of disability in the Metal Period of the Philippines, likely requiring healthcare from others, is presented to explore aspects of group dynamics in this period of antiquity. B243, a middle-aged male excavated from the Napa site in the central Philippines, suffered severe trauma to the right leg resulting in considerable restrictions to mobility and self-maintenance of survival related behaviours such as food provision and hygiene. It is likely that B243 required assistance from others to survive for some period of time prior to eventual death. The bioarchaeology of care method was applied to assess the types of healthcare that B243 likely required, and to consider potential social and biological impacts to both B243 and his community. Provision of healthcare practice in this case suggests that B243's community had access to health-related resources, knowledge on the treatment of his injuries and underlying values in the group for sustaining human life in the case of injury and disability.
http://ift.tt/2ltYBC0
Towards a best practice for the use of active non-contact surface scanning to record human skeletal remains from archaeological contexts
Abstract
Active surface scanners emit light or a laser stripe to record the exterior surface of an object or landscape, providing results in three dimensions. The use of active surface scanners to record anthropological and archaeological contexts has increased within the last few years, creating a number of sub-contexts within these disciplines, and allowing a further development of certain applications, such as quantitative analysis, the use of replicas in education and museums, and the creation of digital databases archived in institutions. However with guidance, this paper aims to assess the advantages and disadvantages of active surface scanning and the potential for research with regards to the recording and analysis of human skeletal remains. The key advantages and uses identified include: quantitative digitisation, geometric morphometric studies, conservation, preservation, documentation, and reconstruction. However, surface scanning also has some limitations, including: cost, technological expertise, the need for a power source, computing requirements, and data size. Overall, the application of active surface scanning technology to archaeological skeletal remains will provide a vital digital archive that will serve to preserve the integrity of this fragile and finite resource for future generations. This is particularly important within the current developer-funded environment in which many skeletal collections, including those yielding unique or unusual pathological or morphological features, are re-buried, with only very limited time for analysis.
http://ift.tt/2m6Qz5u
Traumatic aneurysm of the cortical middle cerebral artery
Description
A right-handed man aged 79 years presented with increasing confusion following a mechanical fall with head strike 2 weeks prior. CT demonstrated a left frontoparietal convexity subacute subdural haematoma (SDH) measuring 3 mm in depth and with 5 mm of midline shift to the right (figure 1). There was no skull fracture. Initial examination revealed no localising neurological deficit and he was admitted for observation. On day 3, the patient developed intermittent episodes of right-sided weakness and expressive dysphasia. Contrast MRI showed expansion of the SDH to 10 mm in thickness, and also demonstrated a 9 mm vividly enhancing focus within the haematoma overlying the frontal lobe (figure 2). The lesion enhanced on the arterial and venous phases of contrast CT (figure 3). Digital subtraction angiography demonstrated the lesion to be a 6 mm sidewall aneurysm of the cortical middle cerebral artery (MCA) (figure...
http://ift.tt/2m6WPKD
Intraoral ulcer due to non-invasive positive pressure ventilation: an overlooked complication
Description
A male patient aged 81 years reported with dyspnoea and loss of consciousness, at our emergency department. His respiratory rate was 30 breaths/min, and his level of consciousness determined using the Glasgow Coma Scale was eye (1), verbal (1) and motor (4). Despite oxygen administration via a bag valve mask, his percutaneous oxygen saturation level was measured as only 81%. Physical examination revealed weak vesicular sound on auscultation, suggesting he had severe emphysema. Arterial blood gas analysis after continuous bag valve mask ventilation revealed pH 7.014, undetectably high pCO2 and pO2 of 89 tor. The patient was admitted with the diagnosis with acute exacerbation of chronic obstructive pulmonary disease (COPD). Insufficient spontaneous breathing required installation of mask-type non-invasive positive pressure ventilation (NIPPV: FiO2, 0.35, IPAP, 10 cm H2O, EPAP, 3 cm H2O). After continuous NIPPV support for 8 days, an intraoral ulcer was detected on the patient's lower lip (figure 1)....
http://ift.tt/2ltGaNX
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