One-lung ventilation using a bronchial blocker tube for a large tracheal carcinoma resection

Successful one-lung ventilation using a bronchial blocker tube for a large tracheal carcinoma resection

από Xuelian Zhao, Jianfeng Fu, Xuan Zhou, Shasha Zhang στο Journal of Clinical Anesthesia

Μετάφραση άρθρου

The informed consent was obtained from the patient. A 57-year old woman was diagnosed as a trachea adenoid cystic carcinoma. A large tumor was found in the upper tracheal under fiber bronchoscopy (FBO), which the lower edge of the tumor was about 3cm proximal to the carina and the tumor size was about 4cm, obstructing the tracheal lumen by 92%. The gap at the narrowest intraluminal point was about 0.5cm (Fig.1A, B). Abnormal FEV 1% FVC: 22.07 and PaO2: 6.5kPa were detected by pulmonary function test and arterial blood gas test on room air respectively.

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

6948891480

alsfakia@gmail.com

Issue Information - Journal Info page

No abstract is available for this article.

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Issue Information - TOC

No abstract is available for this article.

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CYCORE: Cyberinfrastructure for Comparative Effectiveness Research - Feasibility Trial

Conditions:   Advanced Cancers;   Colorectal Cancer;   Head And Neck Cancer;   Cancer Survivors
Interventions:   Device: Smart phone;   Device: Accelerometers;   Device: Blood Pressure Monitor;   Other: Telephone Surveys;   Other: Home Visit;   Device: Home Health Hub and Modem;   Device: Carbon Monoxide (CO) Monitor;   Device: Heat Rate Monitor;   Device: Global Positioning System (GPS) Device;   Other: Surveys;   Device: Weight Scale;   Device: Fitbit Monitor;   Behavioral: At-Home Exercise Program;   Behavioral: Physical Fitness Tests;   Behavioral: Questionnaires;   Behavioral: Lean Body Mass Assessment
Sponsors:   M.D. Anderson Cancer Center;   National Cancer Institute (NCI)
Recruiting - verified April 2017

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Survey Study and Records Review of Treatment Outcomes in Freeman-Sheldon Syndrome

Conditions:   Freeman-Sheldon Syndrome;   Arthrogryposis Distal Type 2A;   Whistling Face Syndrome;   Craniocarpotarsal Dysplasia;   Craniocarpotarsal Dystrophy;   Freeman-Sheldon Syndrome Variant;   Sheldon-Hall Syndrome;   Arthrogryposis Distal Type 2B;   Gordon Syndrome;   Arthrogryposis Distal Type 3;   Arthrogryposis Distal Type 1;   Arthrogryposis, Distal, Type 1A;   Arthrogryposis Distal Type 1B;   Arthrogryposis, Distal;   Craniofacial Abnormalities;   Arthrogryposis
Interventions:   Other: PTSD Checklist-Civilian (PCL-C);   Other: Modified Flanagan Quality of Life Scale;   Other: Center for Epidemiologic Studies Depression Scale (CES-D);   Other: Functional Enquiry (or Review of Systems) Form;   Other: Study of Therapeutic Outcomes and Practices in Freeman-Sheldon Syndrome (STOP-FSS) Questionnaire;   Other: FSRG Semi-Structured Quality of Life Interview (FSRG SSQLI);   Other: Medical Records Review
Sponsor:   Freeman-Sheldon Research Group, Inc.
Recruiting - verified April 2017

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Neue Therapieoption bei Acne vulgaris

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Narben effektiv behandeln

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Mit Nadeln gegen Narben

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Haartransplantation

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Neue Optionen der Teamarbeit in Kommunen

Eine Versorgung chronisch Kranker über alle Sektoren und Betreuungsbereiche hinweg ist in Deutschland meist noch Utopie. Doch mancherorts gibt es Keimzellen für neue Modelle mit Vorbildcharakter.

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Dermatokosmetika bei Akne: Was ist empfehlenswert?

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ADK aktiv bei dermatologischen Fortbildungen

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Tagung Dermatologische Praxis 2017

Bei der Dermatologischen Praxis in Frankenthal konnten die Teilnehmer wieder aus einer Vielzahl an unterschiedlichen Veranstaltungen mit über 70 Referenten auswählen. Ein Schwerpunkt war am Samstag die Behandlung der Akne. Ebenfalls am Samstag hatten die Besucher auch Gelegenheit, sich in einem Workshop der Arbeitsgemeinschaft Ästhetische Dermatologie und Kosmetologie (ADK) aus erster Hand über wichtige Themen der ästhetischen Medizin zu informieren.

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Zytologie in der dermatologischen Praxis

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Mustervorlage für Hygieneplan

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Atopisches Ekzem: Proaktiv behandeln!

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Wasserlöslicher Nagellack

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Nicht invasives Lifting

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Inhaltsverzeichnis

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Die Adhärenz junger Akne-Patienten verbessern — aber wie?

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Pigmentverändungen vorbeugen

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Sterbegeld muss versteuert werden

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Lichttherapie gegen Juckreiz: UV-B nicht mit UV-A kombinieren!

Bei Patienten mit Psoriasis oder atopischem Ekzem bringt es für den Juckreiz offenbar nichts, eine Phototherapie mit UV-B-Strahlen durch einen UV-A-Anteil zu ergänzen. Angesichts möglicher kumulativer Nebenwirkungen empfehlen Schweizer Forscher, die Indikation für den UV-A-Zusatz restriktiv zu stellen.

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„Es klappt ja doch mit Familie!“

Beruf und Familie — das funktioniert auch in eigener Praxis. Vielleicht sogar besser als im Krankenhaus. Diese Erkenntnis konnten junge Ärzte vom „Tag der Chancen" in Thüringen im März mitnehmen.

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„Ganzkörper-Lichttherapie oft zu früh abgesetzt“

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On “Cleft relapse and oronasal fistula after Furlow palatoplasty in infants with cleft palate: incidence and risk factors” by Li et al.

I read with great interest the study by Li et al. entitled "Cleft relapse and oronasal fistula after Furlow palatoplasty in infants with cleft palate: incidence and risk factors"1. The aim of the study was to investigate the risk factors for the development of postoperative cleft relapse and oronasal fistula after Furlow palatoplasty. By using multivariate analysis, they showed that only the width of the cleft had a statistically significant impact on the incidence of cleft relapse and oronasal fistula.

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A randomized clinical trial about presence of pathogenic micro-flora and risk of peri-implantitis: comparison of two different types of implant-abutment connections

OBJECTIVE: The aim of this in vivo study was to evaluate two different types of implant-abutment connections: screwed connection and cemented connection, analyzing peri-implant bacteria microflora as well as other clinical parameters.

PATIENTS AND METHODS: Twenty implants were selected, inserted in 20 patients, 10 with a screwed implant-abutment connection (Group 1) and 10 with a cemented implant-abutment connection (Group 2). The peri-implant microflora was collected, after at least 360 days from the prosthetic rehabilitation, using paper points inserted in peri-implant sulcus for 30 s. Polymerase chain reaction (PCR) Real-time analyzed the presence of 9 bacteria periodontal-pathogens and Candida albicans.

RESULTS: Our findings showed that bacteria colonized all Groups analyzed, the average bacterial count was 3.7 E +08 (±1.19) in Group 1, compared to 2.1 E +08 (±0.16) in Group 2; no statistically significant differences were observed (p>0.0.5). In Group 1, however, bacterial colonization of peri-implant sulci was over the pathogenic threshold for 5 bacteria, indicating a high-risk of peri-implantitis. Also in Group 2, results showed a microflora composed by all bacteria analyzed but, in this case, bacterial colonization of peri-implant sulci was over the pathogenic threshold for only 1 bacterium, indicating a lower risk of peri-implantitis. Moreover, clinical parameters (PPD > 3 mm and m SBI > 0) confirmed a greater risk of peri-implantitis in Group 1 compared to Group 2 (p<0.05).

CONCLUSIONS: We concluded that, also after only 360 days, implants with screwed connection showed a higher risk of peri-implantitis that implants with cemented connection.

L'articolo A randomized clinical trial about presence of pathogenic micro-flora and risk of peri-implantitis: comparison of two different types of implant-abutment connections sembra essere il primo su European Review.

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Contemporary surgical management of hypodontia

Hypodontia is the term most commonly applied to the condition in which teeth congenitally fail to develop. Such cases differ from teeth that have been lost early or that have failed to erupt, although their initial presentation may be similar and therefore not recognised. The range of missing teeth and their physical and psychological results is large, and the difference in complexity in the management of a patient with isolated hypodontia compared with one with oligodontia or anodontia together with skeletal and orthognathic discrepancies should not be underestimated.

http://ift.tt/2o2Jr6r

New technique for midpalatal osteotomy in surgically-assisted rapid palatal expansion

Surgically-assisted rapid palatal expansion is an acceptable approach for the correction of a transverse deficiency of the maxilla in skeletally mature patients (Fig. 1). Although it is effective, there may be serious complications,1 such as the loss of periodontal bone and the central incisors,2 but preoperative orthodontic preparation minimises the risk. Separation of the roots of the central incisors by preoperative orthodontic management improves overall clinical success, but the risk of dental complications still exists.

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Bilateral submandibular rhabdomyomas: case report

Rhabdomyoma is a benign tumour of striated muscle, and outside the heart they are rare and classified as adult, fetal, and genital subtypes.1 They are found twice as often in men as women, and commonly in adults over 40 years old.2 Of the 115 reported cases of extracardiac rhabdomyoma, 76% were found in the head and neck, but rarely in the submandibular space.3 We describe an exceptional example of bilateral rhabdomyomas in the submandibular spaces.

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Chirurgische Prävention hereditärer gastrointestinaler Tumordispositionen

Zusammenfassung

Hintergrund

Tumorerkrankungen stellen die zweithäufigste Todesursache in der industrialisierten Welt dar. Das zunehmende Verständnis der molekularen Ätiopathogenese von Tumoren und des Einflusses auf die klinische Heterogenität und das Therapieansprechen hat zu einer Präzisierung onkologischer Strategien geführt. Hereditäre Dispositionssyndrome werden aufgrund fehlender Awareness hierzulande nur zu einem kleinen Anteil durch klinische und konsekutive molekulargenetische Testung identifiziert. In Anbetracht des weitreichenden Benefits für Betroffene und deren Familien wären systematische molekulargenetische Untersuchungen bei allen gastrointestinalen Tumoren sinnvoll.

Methode

Eine Recherche und Auswertung aktueller Literatur wurden durchgeführt.

Ergebnisse und Schlussfolgerungen

Durch Identifikation von Mutationsträgern eröffnen sich zahlreiche Optionen für Präventionsstrategien. Diese reichen von einer Änderung der Lifestyle-Faktoren über eine medikamentöse Prävention bis hin zu risikoreduzierenden prophylaktischen Operationen. Allerdings muss hierbei das syndrombezogene Risiko des Auftretens der Tumorerkrankung (Penetranz) unter Berücksichtigung des Gens oder evtl. des genauen Genlokus und des Geschlechts (Gender) sowie des Alters mit der Morbidität jeder Maßnahme genau abgewogen werden. Es ist die Rolle der Behandler unterschiedlicher Disziplinen, über die Möglichkeiten und Grenzen präventiver Maßnahmen so zu beraten, dass Betroffene eine informierte Entscheidung treffen können. In dieser Übersichtsarbeit werden der aktuelle Stand präventiver Optionen in der Behandlung hereditärer Tumorerkrankungen des Gastrointestinaltrakts dargestellt und Konsequenzen für das klinische Management diskutiert.

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Calculus migration characterization during Ho:YAG laser lithotripsy by high-speed camera using suspended pendulum method

Abstract

Calculus migration is a common problem during ureteroscopic laser lithotripsy procedure to treat urolithiasis. A conventional experimental method to characterize calculus migration utilized a hosting container (e.g., a "V" grove or a test tube). These methods, however, demonstrated large variation and poor detectability, possibly attributed to the friction between the calculus and the container on which the calculus was situated. In this study, calculus migration was investigated using a pendulum model suspended underwater to eliminate the aforementioned friction. A high-speed camera was used to study the movement of the calculus which covered zero order (displacement), first order (speed), and second order (acceleration). A commercialized, pulsed Ho:YAG laser at 2.1 μm, a 365-μm core diameter fiber, and a calculus phantom (Plaster of Paris, 10 × 10 × 10 mm³) was utilized to mimic laser lithotripsy procedure. The phantom was hung on a stainless steel bar and irradiated by the laser at 0.5, 1.0, and 1.5 J energy per pulse at 10 Hz for 1 s (i.e., 5, 10, and 15 W). Movement of the phantom was recorded by a high-speed camera with a frame rate of 10,000 FPS. The video data files are analyzed by MATLAB program by processing each image frame and obtaining position data of the calculus. With a sample size of 10, the maximum displacement was 1.25 ± 0.10, 3.01 ± 0.52, and 4.37 ± 0.58 mm for 0.5, 1, and 1.5 J energy per pulse, respectively. Using the same laser power, the conventional method showed <0.5 mm total displacement. When reducing the phantom size to 5 × 5 × 5 mm³ (one eighth in volume), the displacement was very inconsistent. The results suggested that using the pendulum model to eliminate the friction improved sensitivity and repeatability of the experiment. A detailed investigation on calculus movement and other causes of experimental variation will be conducted as a future study.

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Dysregulated homeostasis of target tissues or autoantigens - a novel principle in autoimmunity

Publication date: Available online 11 April 2017
Source:Autoimmunity Reviews
Author(s): Frank Petersen, Xiaoyang Yue, Gabriela Riemekasten, Xinhua Yu
Monogenic autoimmune disorders provide a powerful tool for our understanding of the principles of autoimmunity due to the obvious impact of a single gene on the disease. So far, approximately 100 single gene defects causing murine monogenic autoimmune disorders have been reported and the functional characterization of these genes will provide significant progress in understanding the nature of autoimmunity. According to their function, genes leading to monogenic autoimmune disorders can be categorized into two groups. An expectable first group contains genes involved in the homeostasis of the immune system, including homeostasis of immune organs and immune cells. Intriguingly, the second group consists of genes functionally involved in the homeostasis of target tissues or autoantigens. According to our novel hypothesis, we propose that autoimmunity represents a consequence of a dysregulated homeostasis of the immune system and/or its targets including autoantigens and target tissues. In this review we refer to both aspects of homeostasis in autoimmunity with a highlight on the role of the homeostasis of target tissues and antoantigens.



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Primary Extracranial Meningioma: A Rare Location

Abstract

Meningiomas are benign extraaxial tumors of the central nervous system (CNS). Extracranial meningiomas are extremely rare (2%) and can develop as a direct extension from a primary intracranial meningioma or as true primary extracranial meningioma originating from ectopic arachnoid cells. Only eight cases of primary meningioma in the jaw have been reported to date. Extracranial meningiomas are frequently misdiagnosed, resulting in inappropriate clinical management. The aim of this article was to describe the case of a man with an asymptomatic swelling in the right retromolar area over a period of 2 months. Cone beam computed tomography was performed to determine the extension and involvement of the adjacent structures. Histopathological findings and immunohistochemical analysis aided in the diagnosis of primary extracranial meningioma in the mandible and several aspects of this unusual neoplasm are reviewed. The treatment of choice was a partial resection of the mandible and reconstruction with autogenous iliac tricortical bone. Five years after surgery, the patient remains free of disease.

http://ift.tt/2p41Emb

Correlation of frontal sinus recess anatomy with ethnicity, gender, and pathology

Research on frontal sinus cells has been conflicting regarding relationship between frontal sinus cells and frontal sinus disease. There are no published studies regarding gender differences in frontal sinus disease. No comparisons between African Americans and Caucasians and frontal sinus disease have been published. This study attempts to define the above relationships as well as the relationship between number and types of cells and disease.

http://ift.tt/2nCq4WA

Abrasion and blunt tissue trauma study of a novel flexible robotic system in the porcine model

The objective of this study was to determine if a flexible robotic system caused increased tissue reaction when accessing the oropharynx and hypopharynx compared to intubation controls in only 2 scenarios: high speed tissue impact and multiple unit insertions and retractions. The data obtained were submitted as part of the entirety of information submitted for FDA approval.

http://ift.tt/2o2kp7z

Improving resident familiarity with the translabyrinthine approach to the internal auditory canal

To increase otolaryngology resident experience with drilling and dissection of the internal auditory canal (IAC) via a translabyrinthine approach.

http://ift.tt/2nClV4U

Assessing cumulative acute toxicity of chemoradiotherapy in head and neck cancer with or without induction chemotherapy

To compare cumulative acute toxicity in head and neck cancer patients treated with concurrent chemoradiotherapy alone (CCRT) versus induction chemotherapy (IC) followed by CCRT (I/CCRT).

http://ift.tt/2o2qbWK

Successful one-lung ventilation using a bronchial blocker tube for a large tracheal carcinoma resection

The informed consent was obtained from the patient. A 57-year old woman was diagnosed as a trachea adenoid cystic carcinoma. A large tumor was found in the upper tracheal under fiber bronchoscopy (FBO), which the lower edge of the tumor was about 3cm proximal to the carina and the tumor size was about 4cm, obstructing the tracheal lumen by 92%. The gap at the narrowest intraluminal point was about 0.5cm (Fig.1A, B). Abnormal FEV 1% FVC: 22.07 and PaO2: 6.5kPa were detected by pulmonary function test and arterial blood gas test on room air respectively.

http://ift.tt/2owUhWj

Clinical Thyroidology for the Public – Highlighted Article

From Clinical Thyroidology for the Public: Hyperthyroidism, or an overactive thyroid, is a common disorder with an estimated lifetime risk of 2-5% in the general population. Read More….

The post Clinical Thyroidology for the Public – Highlighted Article appeared first on American Thyroid Association.

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CD11b regulates antibody class switching via induction of AID

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Seohyun Park, Hyunsub Sim, Hye-In Kim, Daecheol Jeong, Guang Wu, Soo Young Cho, Young Seek Lee, Hyung-Joo Kwon, Keunwook Lee
The integrin CD11b, which is encoded by the integrin subunit alpha M (ITGAM), is primarily expressed on the surface of innate immune cells. Genetic variations in ITGAM are among the strongest risk factors for systemic lupus erythematosus, an autoimmune disease characterized by the presence of autoantibodies. However, the regulatory function of CD11b in the antibody responses remains unclear. Here, we report the induction of CD11b in activated B2 B cells and define its unexpected role in immunoglobulin heavy chain class switch recombination (CSR). LPS-activated B cells lacking CD11b yielded fewer IgG subtypes such as IgG1 and IgG2a in vitro, and immunization-dependent CSR and affinity maturation of antibodies were severely impaired in CD11b-deficient mice. Notably, we observed the reduced expression of activation-induced cytidine deaminase (AID), an enzyme that initiates CSR and somatic hypermutation, and ectopic expression of AID was sufficient to rescue the defective CSR of CD11b-deficient B cells. LPS-induced phosphorylation of NF-κB p65 and IκBα was attenuated in CD11b-deficient B cells, and hyperactivation of IκB kinase 2 restored the defective AID expression and CSR, which implied that CD11b regulates the NF-κB-dependent induction of AID. Overall, our experimental evidence emphasized the function of CD11b in antibody responses and the role of CD11b as a vital regulator of CSR.



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Positive feedback effect of PGE2 on cyclooxygenase-2 expression is mediated by inhibition of Akt phosphorylation in human follicular dendritic cell-like cells

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Jongseon Choe, Yongdae Yoon, Jini Kim, Yu-Jin Jung
Prostaglandins (PGs) are bioactive lipid mediators generated from the phospholipids of cell membrane in response to various inflammatory signals. To understand the potential role of PGs in PG production itself during immune inflammatory responses, we examined the effect of PGE2, PGF2α, and beraprost on COX-2 expression using follicular dendritic cell (FDC)-like HK cells isolated from human tonsils. Those three PGs specifically augmented COX-2 protein expression in a dose-dependent manner after 4 or 8h of treatment. The enhancing effect was also reflected in the actual production of PGs and the viable cell recovery of germinal center B-cells. To investigate the underlying molecular mechanism, we examined the impact of PI3K inhibitors on PG-induced COX-2 expression. Interestingly, COX-2 induction by PGE2 and beraprost, but not PGF2α, was enhanced by wortmannin and LY294002. In line with this result, Akt phosphorylation was inhibited by PGE2 and beraprost but not by PGF2α. The distinct effect of PGE2 and beraprost from PGF2α was reproduced in Akt-knockdowned HK cells. Our current findings imply that PGE2 and PGI2 stimulate COX-2 expression in FDC by inhibiting Akt phosphorylation. Additional studies are warranted to determine the potential role of Akt as a therapeutic target in patients with inflammatory disorders.



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Dithranol

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Lichtschutz bei Xeroderma pigmentosum

Zusammenfassung

Xeroderma pigmentosum ist eine seltene autosomal-rezessiv vererbte Genodermatose, die durch Mutationen in Genen, verantwortlich für die Reparatur UV-induzierter DNA-Schäden, verursacht wird. Die Erkrankung ist charakterisiert durch erhöhte UV-Lichtsensitivität und eine Poikilodermie, Augenbeteiligung und bei manchen Patienten durch ausgeprägte Sonnenbrände und neurologische Mitbeteiligung. Es besteht ein erhöhtes Risiko für die Entwicklung von Augen- und Hauttumoren an sonnenexponierten Arealen. Derzeit besteht keine kurative Therapie. Als protektive Maßnahme wird ein absoluter Lichtschutz vor allen UV-Strahlungen dringend empfohlen.

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Lichtschutzfaktor 50+

Zusammenfassung

Der Nutzen von Sonnenschutzmitteln mit Lichtschutzfaktoren (LSF) jenseits 50 ist umstritten. Um eine Irreführung des Konsumenten zu vermeiden, sind mehrere Länder bereits dazu übergegangen, LSF über 50 nicht mehr auf Sonnenschutzmitteln zu deklarieren. Argumente gegen hohe LSF sind das Risiko eines unausgewogenen Schutzes, der die Gefahr von Schäden durch längerwellige ultraviolette Strahlung erhöhen könnte; Vermittlung eines falschen Sicherheitsgefühls, das zur zeitlichen Ausdehnung der Sonnenexposition verleiten könnte; gesundheitliche Risiken durch höhere Konzentration an Filtersubstanzen und die nur marginal höhere Lichtblockade. Demgegenüber steht die Erkenntnis, dass der funktionelle LSF von Sonnenschutzmitteln in der praktischen Anwendung ohnehin weit hinter dem deklarierten LSF zurückbleibt und daher der Einsatz von höheren LSF bei sensitiven Individuen und starker UV-Belastung durchaus Sinn machen könnte.

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Erratum zu: Orale Schleimhautalteration – was ist die Ursache?

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Nasenmuschelchirurgie

Zusammenfassung

Die Nase bildet die ersten 8 cm des oberen Respirationstrakts und dient neben der Luftzufuhr der Reinigung, Befeuchtung und Temperierung der Atemluft. Dies wird als Konditionierung bezeichnet. Diffusor und Beschleuniger der Atemluft ist die Nasenklappenregion, gebildet aus dem Kopf der unteren Nasenmuschel, Anteilen des knorpeligen Septums und des Lateralknorpels. Voraussetzungen sind regelrechte mukoziliäre Clearance und ausreichender Luftdurchtritt. Die Hypertrophie der unteren Nasenmuscheln ist eine der häufigsten Ursachen symptomatischer Nasenatmungsbehinderungen. Rhinometrische Verfahren stellen bei unklaren Fällen die erweiterte Diagnostik dar. Neben der konservativen Therapie einer allergischen oder vasomotorischen Rhinitis mittels spezifischer Immuntherapie bzw. topischer Kortikoide gibt es diverse interventionelle Verfahren zur Verkleinerung des Muschelgewebes bei einem hohen Maß an Schonung der respiratorischen Schleimhaut.

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Abrasion and blunt tissue trauma study of a novel flexible robotic system in the porcine model

Publication date: Available online 11 April 2017
Source:American Journal of Otolaryngology
Author(s): Michael Z. Lerner, Michael Tricoli, Marshall Strome
ObjectivesThe objective of this study was to determine if a flexible robotic system caused increased tissue reaction when accessing the oropharynx and hypopharynx compared to intubation controls in only 2 scenarios: high speed tissue impact and multiple unit insertions and retractions. The data obtained were submitted as part of the entirety of information submitted for FDA approval.MethodsThis study consisted of 5 groups of Yorkshire pigs (2 animals per group). On Day 0, all animals were intubated. For group 1 (control), a second endotracheal tube was advanced to just above the vocal cords. In abrasion groups 2 and 3, the flexible robotic system was advanced against the oropharyngeal and hypopharyngeal tissues, respectively. In blunt trauma groups 4 and 5, the flexible robotic system was advanced at maximum speed (22mm/s) to collide with oropharyngeal and hypopharyngeal tissues, respectively. Pre- and post-procedure endoscopic assessments of tissue reaction were performed daily for 4 days. An independent reviewer graded tissue reaction using a 0–3 point scale.ResultsTissue reaction scores at each observation time point for all test groups were less than or equal to control scores except for one instance of moderate scoring (2 out of 3) on Day 2 for an animal in the blunt trauma group where reaction was likely intubation-related rather than device impact related. Otherwise, all flexible robotic system-treated animal scores were less than 1 by Day 4.ConclusionsIn this limited study, the flexrobotic system afforded surgical access to the oropharynx and hypopharynx without an increased level of abrasion or tissue trauma when compared to intubation alone.



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Immune-mediated cytokine storm and its role in severe dengue

Abstract

Dengue remains one of the most important mosquito-borne diseases worldwide. Infection with one of the serologically related dengue viruses (DENVs) can lead to a wide range of clinical manifestations and severity. Severe dengue is characterized by plasma leakage and abnormal bleeding that can lead to shock and death. There is currently no specific treatment for severe dengue due to gaps in understanding of the underlying mechanisms. The transient period of vascular leakage is usually followed by a rapid recovery and is suggestive of the effects of short-lived biological mediators. Both the innate and the adaptive immune systems are activated in severe dengue and contribute to the cytokine production. We discuss the immunological events elicited during a DENV infection and identify candidate cytokines that may play a key role in the severe manifestations of dengue and possible interventions.

http://ift.tt/2opOL7F

Primary Extracranial Meningioma: A Rare Location

Abstract

Meningiomas are benign extraaxial tumors of the central nervous system (CNS). Extracranial meningiomas are extremely rare (2%) and can develop as a direct extension from a primary intracranial meningioma or as true primary extracranial meningioma originating from ectopic arachnoid cells. Only eight cases of primary meningioma in the jaw have been reported to date. Extracranial meningiomas are frequently misdiagnosed, resulting in inappropriate clinical management. The aim of this article was to describe the case of a man with an asymptomatic swelling in the right retromolar area over a period of 2 months. Cone beam computed tomography was performed to determine the extension and involvement of the adjacent structures. Histopathological findings and immunohistochemical analysis aided in the diagnosis of primary extracranial meningioma in the mandible and several aspects of this unusual neoplasm are reviewed. The treatment of choice was a partial resection of the mandible and reconstruction with autogenous iliac tricortical bone. Five years after surgery, the patient remains free of disease.

http://ift.tt/2p41Emb

The state of asthma epidemiology: an overview of systematic reviews and their quality

Recently, we have published an overview of systematic reviews in allergy epidemiology and identified asthma as the most commonly reviewed allergic disease. Building on this work, we aimed to investigate the qu...

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Tumor-associated myeloid cells as guiding forces of cancer cell stemness

Abstract

Due to their ability to differentiate into various cell types and to support tissue regeneration, stem cells simultaneously became the holy grail of regenerative medicine and the evil obstacle in cancer therapy. Several studies have investigated niche-related conditions that favor stemness properties and increasingly emphasized their association with an inflammatory environment. Tumor-associated macrophages (TAMs) and myeloid-derived suppressor cells (MDSCs) are major orchestrators of cancer-related inflammation, able to dynamically express different polarized inflammatory programs that promote tumor outgrowth, including tumor angiogenesis, immunosuppression, tissue remodeling and metastasis formation. In addition, these myeloid populations support cancer cell stemness, favoring tumor maintenance and progression, as well as resistance to anticancer treatments. Here, we discuss inflammatory circuits and molecules expressed by TAMs and MDSCs as guiding forces of cancer cell stemness.

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IDO and galectin-3 hamper the ex vivo generation of clinical grade tumor-specific T cells for adoptive cell therapy in metastatic melanoma

Abstract

Adoptive T cell transfer (ACT) with ex vivo-expanded tumor-reactive T cells proved to be successful for the treatment of metastatic melanoma patients. Mixed lymphocyte tumor cell cultures (MLTC) can be used to generate tumor-specific T cells for ACT; however, in a number of cases tumor-reactive T cell, expansion is far from optimal. We hypothesized that this is due to tumor intrinsic and extrinsic factors and aimed to identify and manipulate these factors so to optimize our clinical, GMP-compliant MLTC protocol. We found that the tumor cell produced IDO and/or galectin-3, and the accumulation of CD4⁺CD25^hiFoxP3⁺ T cells suppressed the expansion of tumor-specific T cells in the MLTC. Strategies to eliminate CD4⁺CD25^hiFoxP3⁺ T cells during culture required the depletion of the whole CD4⁺ T cell population and were found to be undesirable. Blocking of IDO and galectin-3 was feasible and resulted in improved efficiency of the MLTC. Implementation of these findings in clinical protocols for ex vivo expansion of tumor-reactive T cells holds promise for an increased therapeutic potential of adoptive cell transfer treatments with tumor-specific T cells.

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Security “high-tech” individual extra-light device mask 2.0: CAD/CAM evolution

Publication date: Available online 10 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): V. Ramieri, V. Vellone, S. Crimi, P. Cascone
In 2008, we presented our security "high-tech" individual extra-light device mask (SHIELD), a protective shield based on the face cast of an injured soccer player that can be customised. It allows a shortened convalescent period, is comfortable, fits well, and allows the patient to continue to play at a professional level in their chosen sport or activity in the shortest time possible. It has been used often in both amateur and professional categories of many sports, and we now present an update.



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Using cone beam CT to assess the upper airway after surgery in children with sleep disordered breathing symptoms and maxillary-mandibular disproportions: a clinical pilot

Abstract

Background

The surgical excision of anatomic obstructions such as adenoids, palatine or lingual tonsils are commonly performed in children with sleep disordered breathing (SDB). Imaging studies measuring airway changes post-surgery in the SDB pediatric population are scarce, rarely addresses the nasal cavity, and are based on global measures (e.g. volume) that do not represent the complexity of the upper airway anatomy. The purpose of this pilot is to test the feasibility in using cone beam CT (CBCT) to analyze the nasal and pharyngeal airway space post-surgery using meaningful methods of analyses, and correlating imaging findings with clinical outcomes in children with SDB symptoms and maxillary-mandibular disproportion.

Methods

Twelve non-syndromic children with SDB symptoms and jaw disproportions were evaluated by interdisciplinary airway team before and after upper airway surgery. CBCT and OSA-18 quality of life questionnaire pre and post-operatively were completed. Conventional and new airway variables were measured based on 3D models of the upper airways and correlated with OSA-18. Conventional measures include volume, surface area, and cross-sectional area. New airway measures include constriction and patency; point-based analyses.

Results

Eight females and four males were 8.8 ± 2 years with mean BMI of 18.7 ± 3. OSA-18 improved, median (lower quartile-upper quartile) from 64.2 (54.7–79.5) to 37.6 (28.7–43) postoperatively, p < 0.001. The median of all airway measures improved however with very wide range. Subjects with the smallest amounts of constriction relief and/or gain in airway patency presented with least improvement in OSA-18. New airway measures show strong correlation with changes in OSA-18 (ρ = 0.44 to 0.71) whereas conventional measures showed very weak correlation (ρ = −0.04 to 0.37).

Conclusions

Using point-based analyses, new airway measures better explained changes in clinical symptoms compared to conventional measures. Airway patency gained by at least 150% and constriction relief by at least 15% showed marked improvement in OSA-18 by 40–55%, after surgery in the tested cohort.

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Serum periostin relates to type-2 inflammation and lung function in asthma; data from the large population-based cohort Swedish GA(2)LEN

Abstract

Background

Periostin has been suggested as a novel, phenotype-specific biomarker for asthma driven by type-2 inflammation. However, large studies examining relationships between circulating periostin and patient characteristics are lacking and the suitability of periostin as a biomarker in asthma remains unclear.

Aim

To examine circulating periostin in healthy controls and subjects with asthma from the general population with different severity and treatment profiles, both with and without chronic rhinosinusitis (CRS), in relation to other biomarkers and clinical characteristics.

Methods

Serum periostin was examined by ELISA in 1091 subjects aged 17-76 from the Swedish GA(2)LEN study, which included 460 asthmatics with/without chronic rhinosinusitis (CRS), 97 individuals with CRS only, and 203 healthy controls. Clinical tests included measurement of lung function, FeNO, IgE, urinary eosinophil derived neurotoxin (U-EDN) and serum eosinophil cationic protein (S-ECP), as well as completion of questionnaires regarding respiratory symptoms, medication and quality of life.

Results

Although median periostin values showed no differences when comparing disease groups with healthy controls, multiple regression analyses revealed that periostin was positively associated with higher FeNO, U-EDN and total IgE. In patients with asthma, an inverse relationship with lung function was also observed. Current smoking was associated with decreased periostin levels, whereas increased age and lower BMI related to higher periostin levels in subjects both with and without asthma.

Conclusion

We confirm associations between periostin and markers of type-2 inflammation, as well as lung function, and identify novel constitutional factors of importance to the use of periostin as a phenotype-specific biomarker in asthma.

This article is protected by copyright. All rights reserved.

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Primary Extracranial Meningioma: A Rare Location

Abstract

Meningiomas are benign extraaxial tumors of the central nervous system (CNS). Extracranial meningiomas are extremely rare (2%) and can develop as a direct extension from a primary intracranial meningioma or as true primary extracranial meningioma originating from ectopic arachnoid cells. Only eight cases of primary meningioma in the jaw have been reported to date. Extracranial meningiomas are frequently misdiagnosed, resulting in inappropriate clinical management. The aim of this article was to describe the case of a man with an asymptomatic swelling in the right retromolar area over a period of 2 months. Cone beam computed tomography was performed to determine the extension and involvement of the adjacent structures. Histopathological findings and immunohistochemical analysis aided in the diagnosis of primary extracranial meningioma in the mandible and several aspects of this unusual neoplasm are reviewed. The treatment of choice was a partial resection of the mandible and reconstruction with autogenous iliac tricortical bone. Five years after surgery, the patient remains free of disease.

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Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism

Statins and hypothyroidism, independently, can rarely cause rhabdomyolysis. The combination of them especially with concurrent intake of drugs such as diltiazem increases the risk of rhabdomyolysis. Hashimoto's encephalopathy is a rare condition associated with Hashimoto's thyroiditis and some patients with that can present with a stroke like picture. An elderly male who has been on atorvastatin for three years and on diltiazem for a week presented with sudden onset inability to walk and confusion. On examination muscle tenderness was noticed and creatine kinase levels indicated rhabdomyolysis which we attributed to atorvastatin. Patient developed a seizure and myoclonus of masseters. Considering this, his confusion and his neutrophilia and high C-reactive protein levels, empirical antibiotics with dexamethasone were started and the patient responded to that. His cerebrospinal fluid and blood culture reports that arrived later did not show sepsis. After going home also his CK (creatine kinase) levels remained high; TSH (thyroid-stimulating hormone) level test was done and hypothyroidism was diagnosed. His antithyroid peroxidase antibody levels were also very high. We retrospectively think he had Hashimoto's encephalopathy as well. His lipid profile and TSH and CK values returned to normal in that order after a few months of levothyroxine therapy.

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Survival outcomes for cutaneous angiosarcoma of the scalp versus face

ABSTRACT

Background

The primary purpose of this study was to examine whether angiosarcoma outcomes differ for the scalp and face.

Methods

We conducted a retrospective outcomes analysis of 50 patients with cutaneous angiosarcoma treated by curative intent identified from the Princess Margaret Cancer Centre Registry (from 1958 to 2014).

Results

Median survival was 26 months (95% confidence interval [CI], 17.6–34.6) and median follow-up 29 months. For the scalp and face, respectively, the 5-year locoregional control rate was 9% and 53% (p = .04); the recurrence-free survival (RFS) rate was 5% and 27% (p = .017); and the overall survival (OS) rate was 9% and 26% (p = .017). Scalp lesions were larger, more likely to be multifocal, and presented more rapidly once noticed. In multivariate Cox proportional hazards analysis, scalp location was independently prognostic for mortality (hazard ratio [HR], 2.10; 95% CI, 1.03–4.28; p = .04).

Conclusion

Scalp angiosarcoma has worse survival than angiosarcoma of the face. Scalp angiosarcoma tends to be larger at presentation, which may be because it is not noticed until more advanced. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Measuring Cell Free DNA During the Course of Treatment for Esophageal Cancer as a Marker of Response and Recurrence

Conditions:   Esophageal Neoplasm;   Esophageal Neoplasms Malignancy Unspecified;   Esophageal Neoplasms Malignant;   Cancer of Esophagus;   Cancer of the Esophagus;   Esophageal Cancer;   Esophagus Cancer;   Neoplasm, Esophageal
Intervention:   Other: Blood and Tissue Collection
Sponsor:   Mayo Clinic
Not yet recruiting - verified April 2017

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Oropharyngeal Tumor Induction Chemotherapy and Response-stratified Locoregional Therapy Trial in Order to Minimize Long-term Adverse Events

Conditions:   HPV-Related Squamous Cell Carcinoma;   HNSCC
Interventions:   Drug: nab-paclitaxel;   Drug: Carboplatin;   Drug: Nivolumab;   Drug: Cisplatin;   Drug: Hydroxyurea;   Drug: 5-FU;   Drug: Dexamethasone;   Drug: Famotidine;   Drug: Diphenhydramine;   Drug: Paclitaxel;   Procedure: Transoral robotic surgery (TORS);   Radiation: Adjuvant RT;   Radiation: Chemoradiotherapy
Sponsor:   University of Chicago
Not yet recruiting - verified April 2017

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Giant perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass

Perforation of a marginal ulcer (MU) is a complication of Roux-en-Y gastric bypass that can be life-threatening. We report a case of a perforated MU that presented 7 months after surgery with several interesting points for discussion. Firstly, the presentation of the ulcer was cryptic with unreliable investigations. Secondly, the ulcer presented again even after anastomotic revision surgery. Finally, the ulcer and the sepsis associated with perforation presented after months of poor nutritional intake with profound hypoalbuminaemia. Perforated MUs causing malnutrition pose clinicians with the difficult decision of which operation to offer; patch repair, revision of the anastomosis or reversal surgery. This case illustrates that primary reversal surgery for a perforated recurrent MU may be the most appropriate surgical management in this clinical situation.

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Fluorescence in a cryptococcoma following administration of 5-aminolevulinic acid hydrochloride (Gliolan)

A 54-year-old man presented with two episodes of dysarthria and left facial droop. Both episodes resolved by the time of examination. MRI of the brain revealed a right frontotemporal, heterogeneously enhancing mass with surrounding vasogenic oedema, suggestive of a high-grade primary brain neoplasm. The patient was administered preoperative 5-aminolevulinic acid hydrochloride (Gliolan), and fluorescence-guided resection of the lesion was undertaken. Cryptococcus gattii infection was diagnosed from the specimen and the patient was given appropriate antifungal treatment. This is the first reported case of Gliolan-mediated fluorescence in a fungal abscess and highlights one of the potential pitfalls in fluorescence-guided surgery.

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Transperineal aggressive angiomyxoma

A 45-year-old woman with a history of total hysterectomy with adnexal preservation for uterine leiomyomas presented to our hospital with a right gluteal palpable mass, which she first noticed 6 months before and had progressively enlarged since then.

Radiological studies revealed a 14 cm lesion with translevator growth that displaced rather than invaded adjacent structures, with a peculiar whorled pattern on T2-weighted MRI, which enhanced following gadolinium administration. CT-guided biopsy was performed, and in conjunction with imaging features the diagnosis of an aggressive angiomyxoma was assumed and confirmed following surgical excision.

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Urethrocutaneous fistula mimicking vesicocutaneous fistula: a rare entity

Urethral fistulas arising from the anterior urethra usually open on the ventral aspect and are located in the penile, scrotal or perineal region. A diabetic 65-year-old man presented with suprapubic urinary fistula that was communicating with a dorsally located internal urethral opening located in the bulbar region. Such unusual fistula has not been described before.

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Rapidly enlarging acquired capillary hemangioma of the eyelid

DESCRIPTIONCase description

Case 1: A 10-year-old female presented with a 2-week history of a small reddish mass on her right upper eyelid. Her past history was otherwise uneventful. Ocular examination and visual acuity were both normal. The right upper eyelid showed a small reddish mass measuring about 2x2 mm approximately 1 mm from the eyelashes and at the junction of the medial two thirds and lateral one third of the eyelid (figure 1, top panel). The patient was kept under observation as the mass was small, but it rapidly increased in size over the next 2 weeks (figure 1, middle panel). Complete surgical excision was performed after the stalk was clamped and the bleeding blood vessel at the base was cauterised, followed by closure of the skin with 6–0 silk. A cosmetically acceptable result was achieved after 2 weeks (figure 1, bottom panel).

Figure 1

(Top panel) Small reddish mass on...

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Alopecia neoplastica

Description

A woman in her 60s with a history of cutaneous melanoma status post wide local excision and negative sentinel lymph node biopsy more than one decade before presented with 3 weeks of worsening memory, word finding difficulty and changes in handwriting. Her family reported peculiar behaviour such as writing letters on top of (instead of next to) one another and using a hairbrush upside down. The patient also complained of new right leg pain, paraesthesias and a mild frontal headache. Dermatological exam was notable for a 2x2 cm smooth, round nodule on the right parietal scalp, which had been present for a few months and was notable for complete loss of the overlying hair (figure 1). MRI of the brain showed greater than 10 diffusely enhancing lesions suspicious for metastatic disease, with a dominant left parietal haemorrhagic lesion measuring approximately 2.8x2.9x2.2 cm (figure 2). Associated...

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Hereditary leiomyomatosis and renal cell cancer (HLRCC): cutaneous and renal manifestations requiring a multidisciplinary team approach

Cutaneous leiomyomasare rare tumours of smooth muscle origin associated with disorders such as hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. HLRCC is an autosomal dominant syndrome caused by loss of function mutations in the fumarate hydratase gene. Sufferers of this disorder are predisposed to the development of tumours of the skin and/or uterus, with a further subset of HLRCC families at risk of renal cell carcinoma with papillary features. This syndrome is rare and carries with it a significant rate of mortality. A multidisciplinary approach to care is critical in the management of these patients and their families. The dermatologist can play a central role in this process, coordinating care between specialist medical and allied health teams.

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Issue Information

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Serum HE4 is correlated to prognostic factors and survival in patients with endometrial cancer

Abstract

The extent of surgery and the decision for adjuvant treatment in patients with endometrial cancer (EC) depend on the presence of risk factors for lymph node metastases and disease recurrence. Postoperative markers such as myometrial infiltration and specific mutations can select patients for adjuvant treatment but will not influence surgical planning. A biomarker stratifying patients into low-risk and high-risk groups before surgery could identify patients who benefit from more extensive surgery. Therefore, we evaluated the correlation of serum biomarker HE4 with clinical and recently identified prognostic pathological variables and survival. Patients treated for endometrial cancer between 1994 and 2014 were included. Serum HE4 concentration was measured in preoperatively obtained samples. A total of 88 patients were eligible for analysis. The majority (64%) was diagnosed with endometrioid-type adenocarcinoma. Serum HE4 concentration is significantly associated with stage of disease (p = 0.001), deep myometrial invasion (p < 0.001), exact depth of myometrial invasion (≥4 mm) (p = 0.01), tumour-free distance to serosa (≤7 mm) (p < 0.001), extensive lymph vascular space invasion (p = 0.04) and cervical involvement (p = 0.001). HE4 concentration and nodal involvement were correlated, although not significant (p = 0.17). Serum HE4 is an independent prognostic factor for recurrence-free survival (HR 5.12 per 10-fold increase in HE4, 95% CI 1.54–17.1) and overall survival (HR 7.48 per 10-fold increase in HE4, 95% CI 1.76–31.7). HE4 is a prognostic marker in endometrial cancer and is helpful in addition to other variables for the preoperative risk stratification of patients with endometrial cancer.

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An anatomical subunit-based outcome assessment scale for bilateral cleft lip and palate

Publication date: Available online 10 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): K. Bonanthaya, P.N. Shetty, P.S. Fudalej, D.D. Rao, S. Bitra, M. Pabari, M. Rachwalski
As there is currently no internationally accepted outcome measurement tool available for complete bilateral cleft lip and palate (CBCLP), the goal of this prospective study was to develop a numerical evaluation scale that allows reliable scoring of this cleft deformity. Our cohort comprised 121 Indian subjects with CBCLP who underwent surgical repair (mean age at time of surgery 6.53 months) using a modified Millard technique. A panel of three professionals evaluated each subject's outcome of bilateral cleft lip repair 6 months postoperatively on two-dimensional (2D) full-face photographs in the frontal view and worm's eye view. A simple two-point rating system was applied to separately analyse a total of 12 components of lip, nose, and scar. The results and mean scores for the analysed anatomical areas were 2.2±1.01 (max=3) for nose, 5.4±1.54 (max=8) for lip, and 1.9±1.3 (max=3) for scar, with a total score 7.7±2.21 (max=12) indicating a good surgical outcome. The inter-examiner ICC for nose, lip, scar, and total score was calculated at 0.836, 0.889, 0.723, and 0.927 respectively and indicated a strong level of repeatability and reliability that was highly significant (P<0.001). In conclusion, we were able to develop and test a scoring system for measuring outcomes in CBCLP that warrants simplicity of use, reliability and reproducibility.



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The influence of mandibular third molar germectomy on the treatment time of impacted mandibular second molars using brass wire: a prospective clinical pilot study

Publication date: Available online 10 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Cassetta, F. Altieri
The brass wire ligature is an efficient method to correct a moderately mesially impacted mandibular second molar (MM2). The aim of this prospective clinical pilot study was to evaluate the influence of mandibular third molar (MM3) germectomy on the treatment time for this procedure and to determine its impact on oral health-related quality of life (OHRQoL) using the short-form Oral Health Impact Profile (OHIP-14). The STROBE guidelines were followed. Impacted MM2 were assigned randomly to receive brass wire ligature treatment either with germectomy (group A) or without germectomy (group B). Descriptive statistics and the Student t-test were used in the statistical analysis; significance was set at P≤0.05. One thousand and thirty patients were assessed. Fourteen subjects with 20 mesially angulated (range 25–40°) impacted MM2 were identified. Paired comparisons of groups A and B showed no statistically significant difference in treatment time (171days for group A and 174days for group B; P=0.440), but a statistically significant difference in OHIP-14 values at the 3- (P=0.017) and 7-day (P=0.002) follow-up. The brass wire technique can be used effectively in moderately impacted MM2, but the combined use of MM3 germectomy does not influence the treatment time and shows a negative impact on OHRQoL.



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Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen: a case report

High-dose chemotherapy with autologous stem cell rescue is commonly used for the treatment of relapsed germ cell tumors. We report the first case of delayed rhabdomyolysis with paclitaxel, ifosfamide, carbopla...

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Using cone beam CT to assess the upper airway after surgery in children with sleep disordered breathing symptoms and maxillary-mandibular disproportions: a clinical pilot

The surgical excision of anatomic obstructions such as adenoids, palatine or lingual tonsils are commonly performed in children with sleep disordered breathing (SDB). Imaging studies measuring airway changes p...

http://ift.tt/2oTTpfw

B-FAHF-2 plus oral immunotherapy (OIT) is safer and more effective than OIT alone in a murine model of concurrent peanut/tree nut allergy

Abstract

Background

Concurrent sensitization to peanut (PN) and tree nuts (TN), the most dangerous food allergies, is common. Current oral immunotherapy (OIT) is not fully satisfactory.

Objective

To determine if the herbal formula B-FAHF-2 (BF2) ameliorates PN/TN OIT adverse reactions and enhances persistence of a tolerant state.

Methods

Concurrently sensitized peanut, walnut (WN) and cashew (CSH) allergic mice received 1 day PN/WN/CSH rush OIT plus 3 weeks of maintenance dosing, with or without 3-weeks prior and 3-weeks BF2 co-treatment. Anaphylactic symptom scores, core body temperatures, plasma histamine levels, basophil numbers, antigen-specific IgE, cytokine levels, and IL-4, INF-γ and Foxp3 gene promoter DNA methylation status, and their correlation with final challenge symptom scores were determined.

Results

BF2+OIT treated mice experienced significantly fewer and less severe adverse reactions than OIT only treated mice (p<0.01) during the one-day rush OIT buildup dose phase. Both OIT only and BF2+OIT mice showed significant desensitization (p<0.01 and 0.001 respectively) at one-week post therapy challenge; being greater in BF2+OIT mice. All sham treated and 91% of OIT treated mice experienced anaphylaxis whereas only 21% of BF2+OIT treated mice exhibited reactions during 5-6 weeks of dose escalation single PN and TN challenges. Greater and more persistent protection in BF2+OIT mice was associated with significantly lower plasma histamine and IgE levels, increased IFN- γ/IL-4 and IL-10/IL-4 ratios, DNA re-methylation at the IL-4 promoter and de-methylation at IFN-γ and Foxp3 promoters. Final challenge symptom scores were inversely correlated with IL-4 DNA methylation levels (p<0.0002), and positively correlated with IFN-γ and Foxp3 gene promoter methylation levels (p<0.0011) (p<0.0165).

Conclusions and clinical relevance

Combined BF2/OIT therapy was safer and produced longer post treatment protection, and more tolerance-prone immunological and epigenetic modifications than OIT alone. BF2/OIT may provide an additional OIT option for patients with concurrent peanut/ tree nut and other food allergies.

This article is protected by copyright. All rights reserved.

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Contents Vol. 78, 2016

ORL 2016;78:I-IV

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Acknowledgement to Reviewers

ORL 2016;78:361

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Advantage of Kilner’s Modification of Mouth Gag in Reference to Simple Technique Overcoming a Persistent Problem in Cleft Palate Repair

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Intraosseous Leiomyoma of the Mandible: A Case Report of the Rare Entity and Review of Literature

Abstract

Introduction

Leiomyoma is a rare tumor of smooth muscle origin with a very low incidence in the maxillofacial region. Intraosseous occurrence of oral leiomyoma is even rare with involvement of mandible followed by maxilla.

Aim

The purpose of this paper is to present a case of intraosseous leiomyoma of the left mandibular angle region with the review of literature describing this rare entity. The paper also highlights the need to include this entity in differential diagnoses of jaw lesions.

Material and Method

An extensive search of literature was carried out on the Medline-Pubmed and Google Scholar database using the keywords leiomyoma, maxilla, mandible, oral and palate to thoroughly search and collect all the reported cases of intraosseous leiomyoma.

Result

To the best of our knowledge till date only 22 cases of intraosseous leiomyoma have been reported in the maxillomandibular region we represent the 23rd case of the intraosseous leiomyoma in a 36 year old male patient.

Conclusion

Though uncommon but it is known to occur in the jaws therefore intraosseous leiomyoma should be included in the list of differential diagnoses of radiolucent lesion of mandible and maxilla.

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Talus fracture in a 4-year-old child

Fracture of the talus is uncommon in childhood. We report a case of talar neck fracture that occurred in a 4-year-old girl. We present the radiological findings, the orthopaedic follow-up and the clinical outcome.

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Altered Fatty Acid Metabolism and Reduced Stearoyl-Coenzyme A Desaturase Activity in Asthma

Abstract

Background

Fatty acids and lipid mediator signaling play an important role in the pathogenesis of asthma, yet this area remains largely under-explored. The aims of this study were (i) to examine fatty acid levels and their metabolism in obese and non-obese asthma patients and (ii) to determine the functional effects of altered fatty acid metabolism in experimental models.

Methods

Medium- and long-chain fatty acid levels were quantified in serum from 161 human volunteers by LC/MS. Changes in stearoyl-coenzyme A desaturase (SCD) expression and activity was evaluated in the ovalbumin (OVA) and house dust mite (HDM) murine models. Primary human bronchial epithelial cells from asthma patients and controls were evaluated for SCD expression and activity.

Results

The serum desaturation index (an indirect measure of SCD) was significantly reduced in non-obese asthma patients and in the OVA murine model. SCD1 gene expression was significantly reduced within the lungs following OVA or HDM challenge. Inhibition of SCD in mice promoted airway hyperresponsiveness. SCD1 expression was suppressed in bronchial epithelial cells from asthma patients. IL-4 and IL-13 reduced epithelial cell SCD1 expression. Inhibition of SCD reduced surfactant protein C expression and suppressed rhinovirus-induced IP-10 secretion, which was associated with increased viral titers.

Conclusions

This is the first study to demonstrate decreased fatty acid desaturase activity in humans with asthma. Experimental models in mice and human epithelial cells suggest that inhibition of desaturase activity leads to airway hyperresponsiveness and reduced anti-viral defense. SCD may represent a new target for therapeutic intervention in asthma patients.

This article is protected by copyright. All rights reserved.

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Establishment and characterization of a clear cell odontogenic carcinoma cell line with EWSR1-ATF1 fusion gene

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Satoko Kujiraoka, Takaaki Tsunematsu, Yukiko Sato, Maki Yoshida, Ayataka Ishikawa, Rei Tohyama, Michio Tanaka, Yutaka Kobayashi, Tomoyuki Kondo, Aya Ushio, Kunihiro Otsuka, Mie Kurosawa, Masako Saito, Akiko Yamada, Rieko Arakaki, Hirokazu Nagai, Hiromasa Nikai, Kengo Takeuchi, Toshitaka Nagao, Youji Miyamoto, Naozumi Ishimaru, Yasusei Kudo
ObjectiveClear cell odontogenic carcinoma (CCOC) is a rare malignant odontogenic tumor (MOT) characterized by sheets and lobules of vacuolated and clear cells. To understand the biology of CCOC, we established a new cell line, CCOC-T, with EWSR1-ATF1 fusion gene from a mandible tumor with distant metastasis and characterized this cell line.Materials and methodsTo detect the EWSR1-ATF1 fusion gene, we used three CCOC cases, including the present case, by RT-PCR and FISH analysis. We characterized established CCOC-T cells by checking cell growth, invasion and the expression of odontogenic factors and bone-related factors. Moreover, the gene expression profile of CCOC-T cells was examined by microarray analysis.ResultsHistologically, the primary tumor was comprised of cords and nests containing clear and squamoid cells separated by fibrous septa. In addition, ameloblastomatous islands with palisaded peripheral cells were observed, indicating probable odontogenic origin. This tumor expressed the fusion gene EWSR1-ATF1, which underlies the etiology of hyalinizing clear cell carcinoma (HCCC) and potentially that of CCOC. We found a breakpoint in the EWSR1-ATF1 fusion to be the same as that reported in HCCC. Established CCOC-T cells grew extremely slowly, but the cells showed highly invasive activity. Moreover, CCOC-T cells expressed bone-related molecules, odontogenic factors, and epithelial mesenchymal transition (EMT)-related molecules.ConclusionTo the best of our knowledge, this is the first report on the establishment of a CCOC cell line. CCOC-T cells serve as a useful in vitro model for understanding the pathogenesis and nature of MOT.



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Human papillomavirus genotypes and risk of head and neck cancers: Results from the HeNCe Life case-control study

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Claudie Laprise, Sreenath Arekunnath Madathil, Nicolas F. Schlecht, Geneviève Castonguay, Denis Soulières, Phuc Felix Nguyen-Tan, Paul Allison, François Coutlée, Michael Hier, Marie-Claude Rousseau, Eduardo L. Franco, Belinda Nicolau
ObjectiveHuman papillomaviruses (HPV) are changing dramatically the epidemiologic landscape of head and neck cancers (HNCs). Their role in the aetiology of these cancers varies widely among HNCs subsites, sex and geographical regions worldwide. We describe HPV prevalence and its association with HNCs risk overall and by anatomical subsite in a sample of Canadians.Materials and methodsThe HeNCe Life study recruited 460 incident HNCs cases and 458 controls frequency-matched by age and sex from four Montreal hospitals in 2005–2013. We tested oral rinse and oral brush specimens for mucosal HPV genotypes. HPV positivity was categorized hierarchically as either negative, exclusively non-α-9 species types, α-9 types other than HPV16, and HPV16. We estimated odds ratios (OR) and 95% confidence intervals (CI) for the associations between HPV and HNCs using unconditional logistic regression, controlling for confounders.ResultsThe prevalence of HPV infection among controls and cases was 14.5% and 41.2% in oral rinse and 3.1% and 24.4% in oral brush samples, respectively. HPV16 was the predominant genotype with an oral rinse and oral brush prevalence of 26.3% and 16.2% among cases and 2.4% and 0.2% among controls, respectively. HPV infection was associated with an increased risk of HNCs overall (OR=4.18; 95% CI, 2.94–5.95) and oropharyngeal cancer only (OR=10.3; 95% CI, 6.8–15.7). HNCs and oropharyngeal cancer were strongly associated with HPV16 (OR=18.1; 95% CI, 9.1–35.8, and OR=47.2; 95% CI, 23.1–96.6, respectively).ConclusionHPV infection, particularly HPV16, was associated with an increased HNCs risk, most strongly for oropharyngeal cancers.



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