Head and Neck Medicine by Alexandros G.Sfakianakis: 04/13/17

Πέμπτη 13 Απριλίου 2017

Editor-in-Chief’s acknowledgements

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Language, gender and sexual identity: Poststructuralist perspectives Heiko Motschenbacher (2010) and An interdisciplinary bibliography on language, gender and sexuality (2000–2011) Heiko Motschenbacher (2012)

Language, gender and sexual identity: Poststructuralist perspectives Heiko Motschenbacher (2010) Amsterdam and Philadelphia: John Benjamins. Pp. xii + 209 ISBN: 978 90 272 1868 1 (Hb; alk. Paper) ISBN 978 90 272 8750 2 (Eb)

An interdisciplinary bibliography on language, gender and sexuality (2000–2011) Heiko Motschenbacher (2012)Amsterdam and Philadelphia: John Benjamins. Pp. vii + 294 ISBN: 978 90 272 1200 9 (Hb; alk. Paper) ISBN 978 90 272 7315 4 (Eb)

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Street remarks to women in five countries and four languages: Impositions of engagement and intimacy

In this paper I analyze the remarks men make to passing young women on the street in 134 naturally occurring encounters that were video recorded in 2013 and 2014 across ﬁve countries and four languages and posted on the internet. I categorize these remarks in terms of the speech acts they contain, showing the most common acts, in descending order of frequency, to be addressing, greeting, expressing astonishment or admiration, summoning, and asking rhetorical questions. In immediate interactional terms, the great majority of the men's actions are thus oriented to constituting what Goffman (1963) called a 'focused interaction', a face-to-face engagement with a common focus of attention. The very ordinariness of these acts in terms of content and surface meaning – they are not vulgar or explicitly threatening – may explain why defenders of street remarks regularly draw attention to seemingly benign referential or speech act content, e.g., 'He was just saying "Hi"' or 'He was just giving her a compliment'. At another level, however, street remarks impose intimacy on passing strangers, thus ﬂouting the normative conventions for interaction through which we manage social and personal risk and establish trust. Women targeted by street remarks treat them as breaches by not responding to them. The very ordinariness of the language in the street remarks documented, along with the relative difﬁculty of articulating the implicit social conventions that they breach, may veil their harm and indirectly contribute to the perpetuation of male domination of women in public spaces.

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‘ ¡Uy!, ¿quién pidió pollo?’ A qualitative analysis of the piropo practice by construction workers in Bogotá, Colombia

This paper analyzes the discursive practice of piropos performed by construction workers and addressed to female pedestrians in Bogotá, Colombia. Following an interactional sociolinguistic approach, the paper investigates the distinctive features of the piropo practice within this group. The investigators collected 87 naturalistic interactions and 40 interviews of speakers using ethnographic techniques. The analysis includes the study of the content and the form of piropos along with body language and the general performance of the speaker and the addressee. The results show that the speakers follow the patterns of piropo interactions in the Hispanic culture, even though they use speciﬁc features for the preparatory acts, the enunciation, and the offset of piropos. The observational data suggest that the practice is grounded on machismo ideologies that trigger public deployment of masculinity. On the other hand, interview data display speakers' perceptions of piropos as a ﬂirtatious activity and a verbal game. The paper provides naturalistic evidence of the piropo practice in a Hispanic context and contributes to the discussion of gender roles in the public space.

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Discourse in f(r)iction. Production and reception of gender roles discourse in an audio-visual text about piropos

This paper studies the constraints the audience – and also producers – ﬁnd when attempting to deconstruct a traditional gendered practice (piropos) in a recent ﬁctional clip that depicts this practice in an unconventional way, with women as the performers. The production of the clip is analyzed using multimodal discourse analysis tools to explore how the audiovisual text (re)produces speciﬁc gender(ed) meanings at the interplay of several semiotic resources. The reception of the clip is analyzed with the aid of the appraisal model, to study how participants in three focus groups (female, male and mixed) interactively co-construct meanings to evaluate the clip, the producers, the narrative and even the piropos depicted. The discussion centers on three aspects evaluated by participants: the genre/purpose of the text, its open ending or the lack of an explicit moral, and the mismatch between ﬁction and social reality.

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‘ ¡Quién fuera noche para caerle encima!’ Piropos in Chile: Sexual harassment or ﬂirtation?

Piropos, a type of ﬂirtatious street talk, are a discourse practice that social movements against street harassment in Chile have condemned for their male chauvinist and sexist content. This paper analyzes the structure of piropos to see their effects in both the way piropos portray women, and the discourse piropos promote and/or maintain towards women. From a compendium (Memoria chilena, 2008), 67 piropos were selected and grouped based on the conceptual metaphor (Lakoff and Johnson, 2003) they use to represent women in society. Conceptual metaphors represented women as religious entities, food, criminals or offenders, and objects found in nature. A ﬁfth metaphor included under the label 'transﬁguration' represents the objectiﬁcation of the one uttering the piropo in order to get closer to the receiver of this discourse practice. The methodology considered (1) power and social distance (Poynton, 1989; Kerbrat-Orecchioni, 1992) to understand the relationship between the participants of this practice, and (2) transitivity (Halliday, 2014) to understand how lexical choices of both processes and participants reﬂect how human experience is expressed. The analysis revealed that the piropos analyzed use several resources to perpetuate a male chauvinist discourse that objectiﬁes women and considers them as inferior and, generally, powerless.

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Introduction: Space, bodies and boundaries Piropos and other forms of flirtatious street talk as contested discursive practices

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Intercultural contact, language learning and migration Barbara Geraghty and Jean E. Conacher (eds) (2014) London, New Delhi, New York and Sydney: Bloomsbury ISBN 978-1-4411-8992-9 (Hardback). Pp. 224

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Style-shifting in public: New perspectives on stylistic variation Juan Manuel Hernández-Campoy and Juan Antonio CutillasEspinosa (eds) (2012) (Studies in Language Variation 9) Amsterdam and Philadelphia: John Benjamins Pp. vii+231 ISBN 97890272348

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An introduction to sociolinguistics: Society and identity Sharon K. Deckert and Caroline H. Vickers (2011) London: Bloomsbury. Pp. 256 ISBN: 978-1441100283

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Thank you for dying for our country: Commemorative texts and performances in Jerusalem Chaim Noy (2015) Oxford and New York: Oxford University Press ISBN: 978-0-19-939897-3. Pp. 304

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Desarrollo sociolingüístico del voseo en la region andina de Colombia (1555–1976) Ana María Díaz Collazos (2015) [Beihefte zur Zeitschrift für Romanische Philologie, 392] Berlin and Boston: De Gruyter. ISBN 978-1-118-29496-3. Pp. 329

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Language and identity: Discourse in the world David Evans (ed.) (2015) London and New York: Bloomsbury Academic ISBN 9780567338167. Pp x + 233

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Dexamethasone promotes regeneration of crushed inferior alveolar nerve by inhibiting NF-κB activation in adult rats

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Wei Gao, Dongdong Tong, Qing Li, Ping Huang, Fenghe Zhang
PurposeNuclear factor kappa B (NF-κB), which is closely related to inflammation, has become a topic of interest for research. The aim of this study is to investigate the effects of dexamethasone (Dex), an inhibitor of NF-κB, on inferior alveolar nerve injury in adult rats.Materials and methodsThe crushed inferior alveolar model is established in Wistar rats and they are randomly divided into three groups according to treatment: pyrrolidine dithiocarbamate (PDTC), dexamethasone (Dex), and saline (physiological saline). After treatment, the rats are respectively sacrificed at 3, 7, and 14d, and inferior alveolar nerves are extracted for histochemical and western blot analysis.ResultCompared with the PDTC and saline groups, nerve fibers in the Dex group are regularly arranged with few vacuoles, which is similar to normal inferior alveolar nerves. Immunofluorescent results show significantly decreased NF-κB expression in the Dex group. Western bolt shows higher expression of GAP-43 and lower expression of NF-κB.ConclusionTaken together, all results show that dexamethasone significantly improved the regeneration of crushed inferior alveolar nerves by inhibiting NF-κB activation in adult rats.

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Overexpression and varied clinical significance of Th9 versus Th17 cells in distinct subtypes of oral lichen planus

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Hui Wang, Jingping Bai, Zhenhua Luo, Jie Fu, Hongjian Wang, Zheng Sun
ObjectiveOral lichen planus (OLP) presents with large numbers of T lymphocytes accumulating beneath the epithelium of the oral mucosa; however, its aetiology remains obscure. A potential role for an emerging novel T cell subset, Th9, in OLP has recently been suggested but remains to be clarified. The current aim was to investigate the expression and potential clinical significance of Th9 cells in distinct subtypes of OLP.Materials and methodsPeripheral blood samples were collected from 41 OLP patients and 18 healthy controls (HCs). Flow cytometric analysis was used to detect the CD4+ T helper subset Th9 (IL-9⁺IL-17⁻CD4⁺ Th cells) and Th17 (IL-9⁻IL-17⁺CD4⁺ Th cells) expression levels.ResultsFlow cytometry results showed significantly elevated levels of Th9 cells in reticular and erosive OLP compared to HCs. Th9 expression in erosive OLP was less than in reticular OLP, indicating that Th9 but not Th17 cells may play a predominant role in reticular disease. However, in erosive OLP patients, we found much higher levels of Th17 cells compared to reticular OLP patients and HCs, indicating that Th17 dominates in erosive OLP. Statistical analysis showed positive correlations of Th9 cells and Th17 cells in patients with reticular or erosive OLP but none in HCs.ConclusionsTh9 and Th17 cells may take the predominant roles in reticular and erosive OLP respectively, and their numbers were positively correlated in reticular and erosive OLP patients. Elevated circulating Th9 cells may help maintain immune balance in OLP immunopathogenesis, which requires further investigation.

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Hypermethylation of Death-Associated Protein Kinase (DAPK1) and its association with oral carcinogenesis - An experimental and meta-analysis study

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Chinchu Jayaprakash, Vinay Koshy Varghese, Ravishankara Bellampalli, Raghu Radhakrishnan, Satadru Ray, Shama Prasada Kabekkodu, Kapaettu Satyamoorthy
ObjectivesThe value of abnormal DNA methylation of DAPK1 promoter and its association with various cancers have been suggested in the literature. To establish the significance of DNA methylation of DAPK1 promoter in oral squamous cell carcinoma (OSCC), we a) performed a case-control study, b) evaluated published data for its utility in the diagnosis and prognosis of OSCC and c) identified the association of DAPK1 gene expression with promoter DNA methylation status.DesignBisulfite gene sequencing of DAPK1 promoter region was performed on non-malignant and malignant oral samples. Further, using a systematic search, 330 publications were retrieved from PubMed, Scopus, and Google Scholar and 11 relevant articles were identified.ResultsSignificant association of DAPK1 promoter methylation with OSCC (p<0.0001) was observed in the case-control study. The studies chosen for meta-analysis showed prognostic and predictive significance of DAPK1 gene promoter, despite defined inconsistencies in few studies. Overall, we obtained a statistically significant (p-value<0.001) association for both sensitivity and specificity of DAPK1 DNA promoter methylation in oral cancer cases, without publication bias.ConclusionDNA hypermethylation of DAPK1 gene promoter is a promising biomarker for OSCC prediction/prognostics and suggests further validation in large distinct cohorts to facilitate translation to clinics.

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Dexamethasone promotes regeneration of crushed inferior alveolar nerve by inhibiting NF-κB activation in adult rats

Overexpression and varied clinical significance of Th9 versus Th17 cells in distinct subtypes of oral lichen planus

Hypermethylation of Death-Associated Protein Kinase (DAPK1) and its association with oral carcinogenesis - An experimental and meta-analysis study

Intracellular DNA sensing pathway of cGAS-cGAMP is decreased in human newborns and young children

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Zhan-sheng Wang, Yu-lu Liu, Nan Mi, Dao-yun Duan
Newborns are highly susceptible to DNA virus infections, which may result from the characteristics of neonatal innate immune systems. Here we analyzed for the first time the development of innate immune sensing and signaling of intracellular DNA virus infection in human newborns and young children. Both mRNA and protein expression of cGAS, an intracellular DNA sensor, were shown to be significantly reduced in neonatal peripheral blood mononuclear cells (PBMCs). In addition, cGAS expression in neonatal PBMCs could be induced upon herpes simplex virus type 1 (HSV-1) or interferon-α (IFNα) stimulation. Furthermore, production of the second messenger cGAMP and activation of the transcriptional factor IRF3 was severely decreased in neonatal cord blood mononuclear cells (CBMCs) or PBMCs compared with adults. In contrast, the downstream signaling STING-TBK1-IRF3 appeared to be functional in neonatal PBMCs, as demonstrated by the fact that IRF3 phosphorylation and IFNβ production in these cells could be activated by cGAMP. Intriguingly, decreased expression of cGAS in neonatal cells can be rescued by DNA demethylation, with concomitant enhancement in IFNβ induction by HSV-1. Thus, cGAS restoration or STING stimulation by small molecules during infancy might improve the age-dependent susceptibility to DNA virus infection.

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Infection control practices in Mohs micrographic surgery: a U.K. national survey

Abstract

Mohs micrographic surgery (MMS) is generally considered a safe and effective method of treating certain types of skin cancers, with low reported rates of surgical site infections.^1,2 Practices relating to infection control vary considerably amongst surgeons. Furthermore, emerging evidence suggests clean surgical techniques do not increase infection rates compared to sterile surgical techniques. We sought to establish the current infection control practices amongst surgeons practising MMS in the U.K.

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A novel link between keratoderma and cardiomyopathy: Contiguous gene deletion involving the desmoglein gene cluster

Abstract

Desmocollin and desmoglein proteins are important in intercellular adhesion in both the skin and the heart.¹ Heterozygous mutations in desmocollin 2 (DSC2)² and desmoglein 2 (DSG2)³ can both result in desmosomal dysfunction in cardiomyocytes, leading to development of fibro-fatty tissue, termed arrythmogenic right ventricular cardiomyopathy (ARVC). Heterozygous truncating mutations in desmoglein 1 (DSG1), an intervening gene, can present as a striate palmoplantar keratoderma, whilst homozygous DSG1 mutations can cause severe dermatitis, allergies and metabolic wasting.⁴ Unlike mutations in plakoglobins and desmoplakins that affect both tissues, the desmogleins, desmocollins and plakophillins typically affect either skin or heart.¹ Here we present a patient with a novel heterozygous deletion resulting in loss of a 2.6Mb region including DSC2, DSG2 and DSG1, associated with ARVC and keratoderma (Fig. 1).

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Evolution of the skin manifestations of X-linked Pigmentary Reticulate Disorder

Abstract

X-linked reticulate pigmentary disorder (XLPDR, MIM 301220) is a rare syndrome first recognized by Partington¹. The cardinal manifestations of the disorder are diffuse reticulate hyperpigmentation, hypohidrosis, and unique facial features, as well as recurrent pneumonias and sterile inflammation in various organs^1-9. The syndrome is exceedingly rare and only 20 patients have been reported worldwide. Recently, we identified that the disorder is associated with a recurrent intronic mutation in POLA1, the gene encoding the catalytic subunit of DNA Polymerase-α⁹. Here, we report a new case of XLPDR and include the first detailed description of the evolution of its dermatologic features, as well as confirmation of the same intronic POLA1 mutation.

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Targeted next-generation sequencing identifies 9 novel FLG variants in Chinese Han patients with ichthyosis vulgaris

Abstract

Ichthyosis vulgaris (IV, OMIM #146700) is a common semidominant disorder of keratinization, which is characterized by the xerosis, scaling, keratosis pilaris, palmar and plantar hyperlinearity, and a strong association with atopic disorders.¹

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Can local radiotherapy and IL-12 synergise to overcome the immunosuppressive tumor microenvironment and allow “in situ tumor vaccination”?

Abstract

The abscopal effect, which is the spontaneous regression of tumors or metastases outside the radiation field, occurs rarely in cancer patients. Interestingly, radiotherapy (RT) triggers an immunogenic cell death (ICD) that is able to generate tumor-specific cytotoxic CD8⁺ T cells that are efficient in killing cancer cells. The key question is: why is this "abscopal effect" so uncommon in cancer patients treated with RT? Most probably, the main reason may be related to the highly immunosuppressive tumor microenvironment of well-established tumors that constantly antagonizes the anti-tumor immune responses triggered by RT. In this case, additional or combinatorial immunotherapy is needed to attenuate these immunosuppressive networks and, therefore, substantially increases the efficacy of RT. Here, we describe a potentially promising synergistic radio-immunotherapy "in situ tumor vaccination" protocol by antagonizing the tumor-immunosuppressive microenvironment with a combinatorial approach using local RT and IL-12-based TH1 response augmentation.

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The Summit for Cancer Immunotherapy (Summit4CI), June 26–29, 2016 Halifax, Canada

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Masthead

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Issue Information - Contents

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Cover Image

The cover image, by Andrew Rosko et al., is based on the Original Article Positron emission tomography–CT prediction of occult nodal metastasis in recurrent laryngeal cancer, DOI: 10.1002/hed.24719.

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Clinical, functional and inflammatory characteristics in patients with pauci-granulocytic stable asthma: comparison with different sputum phenotypes

Abstract

Background

According to induced sputum cell count, four different asthma phenotypes have been recognised(eosinophilic, neutrophilic, mixed and pauci-granulocytic). The aim of the present study was to detect functional and inflammatory characteristics of patients with pauci-granulocytic asthma.

Methods

240 asthmatic patients were categorised in the four phenotypes according to cell counts in induced sputum. All patients underwent pulmonary function tests, and measurement of FeNO. The levels of IL-8, IL-13, and ECP were also measured in sputum supernatant. Treatment, asthma control and the presence of Severe Refractory Asthma(SRA) were also recorded.

Results

Patients were categorized in the four phenotypes as follows: eosinophilic (40%), mixed (6.7%), neutrophilic (5.4%) and pauci-granulocytic (47.9%). Although ACT did not differ between groups (p=0.288) patients with pauci-granulocytic asthma had better lung function (FEV₁%pred) (median (IQR):71.5(59.0-88.75) vs 69.0(59.0-77.6) vs 68.0(60.0-85.5) vs 80.5(69.7-95.0), p=0.009] for eosinophilic, mixed, neutrophilic and pauci-granulocytic asthma respectively, p=0.009). SRA occurred more frequently in the eosinophilic and mixed phenotype (41.6% and 43.7% respectively) and less frequently in the neutrophilic and pauci-granulocytic phenotype (25% and 21.7% respectively, p=0.01). FeNO, ECP and IL-8 were all low in the pauci-granulocytic, whereas as expected FeNO and ECP were higher in eosinophilic and mixed asthma, while IL-8 was higher in patients with neutrophilic and mixed asthma(p<0.001 for all comparisons). Interestingly, 14.8% of patients with pauci-granulocytic asthma had poor asthma control.

Conclusion

Pauci-granulocytic asthma most likely represents a "benign" asthma phenotype, related to a good response to treatment, rather than a "true" phenotype of asthma. However, pauci-granulocytic patients that remain not-well-controlled despite optimal treatment represent an asthmatic population that requires further study for potential novel targeted interventions.

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Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: a systematic review

Abstract

Chronic spontaneous urticaria (CSU) patients are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG anti-thyroid autoantibodies (AAbs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase (TPO) are more often elevated in CSU than those of other IgG anti-thyroid AAbs (strong evidence). Levels of IgG anti-thyroid AAbs are more often elevated in adult CSU patients than in children (strong evidence). CSU patients exhibit significantly higher levels of IgG anti-thyroid AAbs (strong evidence) and IgE-anti-TPO (weak evidence) than controls. Elevated IgG anti-thyroid AAbs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in CSU patients (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves' disease (strong evidence). Thyroid dysfunction is more common in adult CSU patients than in children (strong evidence) and in female than male CSU patients (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in healthy controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes and complement.

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Transcriptome analysis of severely active chronic spontaneous urticaria shows an overall immunological skin involvement

Abstract

Background

The knowledge about chronic spontaneous urticaria (CSU) phenotypes is based on its clinical characteristics, associated comorbidities, course of the disease and its response to the available effective drugs. Genotype expression and its further correlation with CSU phenotypes are still unknown. We describe the cutaneous transcriptome of patients suffering a severely active CSU refractory to antihistamine treatment.

Methods

Through the bioinformatic analysis of the whole Human Genome with Oligo Microarrays and Quantitative real-time polymerase chain reaction (qPCR), relevant genes expressed in non-lesional [NLS-CSU] and lesional skin [LS-CSU]) and peripheral blood were identified in 20 patients suffering from severely active CSU and 10 healthy controls (HCs)

Results

From 39 genes differentially expressed in NLS-CSU when compared with HCs, 31 (79.48%) were confirmed by qPCR corresponding to genes involved in epidermal homeostasis and dermal repair. From the analysis comparing LS-CSU with NLS-CSU, a selection of 142 genes was studied with qPCR, and 103 (72.53%) were confirmed. Differentially expressed genes in the phenomenon of wheal development are involved in a variety of biological functions as, epidermal differentiation, intracellular signal function, transcriptional factors cell cycle differentiation, inflammation or coagulation. Differentially expressed genes that uniformly increase or decrease along the skin worsening until the wheal appearance are shown.

Conclusion

The skin of CSU patients with a severely active disease shows an overall immunological skin involvement showing a peculiar gene profile.

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Chirurgische Techniken zur Behandlung des Vestibularisschwannoms

Zusammenfassung

Hintergrund

Die Mikrochirurgie der Vestibularisschwannome ist anspruchsvoll, auch wenn nicht jeder dieser Tumoren eine Herausforderung für erfahrene Chirurgen darstellt. Sinnvoll kann man die Entscheidungen zur Balance zwischen Funktionserhaltung und vollständiger Resektion nur gestalten, wenn man die chirurgischen Techniken im Detail kennt und beherrscht.

Ziel der Arbeit

Die mikrochirurgischen Techniken sowie deren Vorzüge und Gefahren werden auf dem aktuellen Stand skizziert.

Methoden

Die Recherche zu den 3 aktuellen Op.-Techniken anhand der wesentlichen Literatur wird durch die Gewichtung der Vorzüge und Komplikationsmöglichkeiten aus eigener Erfahrung ergänzt.

Ergebnisse

Die mikrochirurgischen Zugänge translabyrinthär, retrosigmoidal und subtemporal sind bezüglich ihrer Modifikationen und der damit erzielbaren Op.-Ergebnisse gut dokumentiert. Eine hörerhaltende Tumorentfernung ist nur über die beiden letzteren Zugänge möglich. Indikationsstellung und Funktionserhaltung sind wesentlich von der Tumorgröße und präexistenten neurologischen Defiziten abhängig. Präoperative Diagnostik und Op.-Vorbereitung unterscheiden sich lediglich bezüglich einer für die halbsitzende Position notwendigen transösophagealen Echokardiographie. Die klassischen Op.-Techniken wurden durch ein verfeinertes intraoperatives Monitoring, endoskopische Sicht, spezielle Mikroinstrumente und den Einsatz von Navigationssystemen ergänzt.

Schlussfolgerung

Die Wahl des chirurgischen Zugangs hängt oft wesentlich von der persönlichen Präferenz und Erfahrung des Operateurs ab. Präoperatives Hörvermögen und Ausdehnung des Tumors sind die entscheidenden objektiven Auswahlkriterien.

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Totally implantable hearing system: Five-year hearing results

Objectives/Hypothesis

1) To provide long-term hearing outcome measures of a totally implantable hearing system (implant) and compare to the baseline unaided (BLU) and baseline aided (BLA) conditions, and 2) discuss relevant safety measures.

Study Design

Prospective, nonrandomized, multicenter, single-subject-as-own-control design.

Methods

Fifty-one subjects with mild to severe sensorineural hearing loss were implanted between 2008 and 2009 and enrolled in this postmarket approval study in the setting of private and hospital-based practices. Forty-nine of these subjects completed the 5-year study, which included annual follow-ups. Primary effectiveness endpoints were speech reception threshold (SRT) and word recognition scores at 50 dB (WRS50s). Secondary effectiveness endpoints were WRSs and the Abbreviated Profile of Hearing Aid Benefit (APHAB) scores. Adverse Device Effects (ADEs) and Serious Adverse Device Effects (SADEs) reported during the study period and a comparison of bone conduction scores are submitted as safety measures.

Results

Compared to the BLA condition, 1) SRT scores were improved at every annual follow-up; 2) WRS50s were better in 49%, and the same in 41% at the 5-year follow-up; 3) WRSs were improved by 17% at the 5-year follow-up; and 4) APHAB scores were improved in most subscales at every annual follow-up. There were three SADEs in three subjects and 15 ADEs in 11 subjects. Bone conduction scores increased by 3.7 dB at the 5-year follow-up. Average battery life was 4.9 years.

Conclusions

The implant compared favorably to the subjects' hearing aid throughout the 5-year period in all of the areas measured and was found to be safe.

Level of Evidence

2b Laryngoscope, 2017

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A Young Man With Proptosis Causing Decreased Visual Acuity

A teenage boy had deteriorating vision and swelling in his right eye, right ear pain, and forehead tenderness; endoscopy revealed a fleshy, red soft-tissue mass in the superior nasal cavity. What is your diagnosis?

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Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid

This cohort study determines whether there is an association between biomarker levels in surgical drain fluid of patients with head and neck cancer and disease-free survival and cancer recurrence.

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Preoperative Calcium and Calcitriol and Hypocalcemia After Thyroidectomy

This cohort study compares the incidence of symptomatic hypocalcemia following administration of calcium and calcitriol supplementation given preoperatively and postoperatively vs postoperative therapy alone in patients undergoing total thyroidectomy.

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Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction

This report communicates the findings of the North American Airway Collaborative Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction.

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The autogenous graft versus transport distraction osteogenesis for reconstruction of the ramus–condyle unit: a prospective comparative study

This study aimed to compare the joint function and morphology achieved following condylar reconstruction using sternoclavicular grafts (SCG) versus transport distraction osteogenesis (TDO) in temporomandibular joint (TMJ) ankylosis patients. Twenty-two patients with TMJ ankylosis underwent TMJ reconstruction with SCG or TDO (n=11 each). Radiographic and clinical evaluations were performed at 1 week and at 1, 3, and 6 months post-surgery. Clinical criteria examined included the duration of surgery, mean postoperative mouth opening, excursive jaw movements, and pain scores.

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Computational fluid dynamics study of the pharyngeal airway space before and after mandibular setback surgery in patients with mandibular prognathism

The purpose of this study was to investigate the relationship between the pressure drop in the pharyngeal airway space (ΔPPAS) and the minimum cross-sectional area (minCSA) of the pharyngeal airway before and after mandibular setback surgery using computational fluid dynamics, in order to prevent iatrogenic obstructive sleep apnoea. Eleven patients with mandibular prognathism underwent bilateral sagittal split osteotomy for mandibular setback. Three-dimensional models of the upper airway were reconstructed from preoperative and postoperative computed tomography images, and simulations were performed using computational fluid dynamics.

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Maxilla reconstruction with autogenous bone block grafts: computed tomography evaluation and implant survival in a 5-year retrospective study

This retrospective study was performed to evaluate the bone thickness of the anterior maxillary region after reconstruction with autogenous bone blocks at 6 months and 5 years after surgery using computed tomography (CT) and to determine the implant survival rate. Eleven patients with a horizontal bone deficiency were treated with reconstructive procedures and implant placement. CT measurements were obtained before surgery (T0) and at 6 months (T1) and 5 years (T2) after surgery. The values were analysed statistically (analysis of variance and Tukey's test; P<0.05).

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Phospholipase C-related catalytically inactive protein-knockout mice exhibit uncoupling protein 1 upregulation in adipose tissues following chronic cold exposure

Publication date: Available online 13 April 2017
Source:Journal of Oral Biosciences
Author(s): Kana Oue, Yosuke Yamawaki, Satoshi Asano, Akiko Mizokami, Masato Hirata, Masahiro Irifune, Takashi Kanematsu
ObjectivesWe have previously demonstrated that phospholipase C-related catalytically inactive protein (PRIP) is involved in fat metabolism and energy consumption. However, whether PRIP participates in body energy metabolism in vivo remains to be determined. Therefore, we examined whether PRIP deficiency affects whole-body energy homeostasis, which is modulated by non-shivering thermogenesis in brown adipose tissue, using a cold exposure animal model.MethodsFasting plasma triacylglycerol levels were measured to evaluate fat metabolism in wild-type and Prip-KO mice. In addition, a glucose tolerance test (GTT) and insulin tolerance test (ITT) were performed. To determine changes in energy consumption, mice were exposed to a cold environment for 7 days, and expression of uncoupling protein 1 (UCP1) in brown adipose tissue was analyzed via western blotting.ResultsFasting plasma levels of triacylglycerols were significantly higher in Prip-KO mice than in wild-type mice. However, Prip-KO mice showed a healthy phenotype based on GTT and ITT. UCP1 expression was significantly upregulated in the brown and white adipose tissues of Prip-KO mice exposed to cold conditions.ConclusionPrip-KO mice exhibit greater ability to consume lipids as an energy source, indicating that PRIP modulates of systemic energy expenditure. Our findings provide increased understanding of PRIP-mediated non-shivering thermogenic mechanisms and offers important insights for the treatment and control of obesity.

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Molecular mechanisms for activation of mutant activin receptor-like kinase 2 in fibrodysplasia ossificans progressiva

Publication date: Available online 13 April 2017
Source:Journal of Oral Biosciences
Author(s): Mai Fujimoto, Naoto Suda, Takenobu Katagiri
BackgroundFibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder characterized by progressive heterotopic ossification (HO) in soft tissues such as skeletal muscles, tendons, and ligaments. Gain-of-function mutations in ALK2, a type I receptor for bone morphogenetic proteins (BMPs), have been identified in patients with FOP; however, the molecular mechanisms that result in the activation of ALK2 mutants remain unclear.HighlightFOP-associated mutant ALK2 signaling is further enhanced by BMP type II receptor in a serine/threonine kinase activity-dependent manner. The threonine residue at position 203 (T203) in ALK2 is crucial for this enhancement by BMP type II receptor. Recently, activin A was found to be a critical ligand of ALK2 mutants.ConclusionBMP type II receptor-dependent phosphorylation of ALK2 mutants in response to ligand binding is important for the activation of BMP signaling in FOP. Therefore, the use of anti-activin A compounds would be a novel treatment approach for FOP.

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Significance of intraoperative findings in revision tympanomastoidectomy

The study was designed to assess correlations between intraoperative findings in revision tympanomastoidectomy as predictors of cholesteatoma recurrence.

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Contemporary surgical management of hypodontia

Publication date: Available online 12 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Breeze, M.S. Dover, R.W. Williams
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. Surgical interventions primarily involve augmentation of bone before placement of an implant, but may include techniques such as distraction osteogenesis and orthognathic surgery. These patients are best managed by a multidisciplinary team, and in this review our aim has been to describe the role of oral and maxillofacial surgeons within it.

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

Publication date: Available online 12 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Behnia, M. Esmaeelinejad, L. Eslamian, S.R. Motamedian

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Bilateral submandibular rhabdomyomas: case report

Publication date: Available online 12 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): V.N. Mistry, P.H. Whitfield, A.N. Brown

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Combined endonasal and eyelid approach for management of extensive frontal sinus inverting papilloma

Objectives

Sinonasal inverting papilloma (IP) is a benign but locally aggressive mucosal neoplasm with a high recurrence rate. Extension into the frontal sinus presents surgical challenges for endonasal resection. This study presents an orbitofrontal approach for managing extensive IP.

Study Design

Case series.

Methods

Four patients seen between 2012 and 2016 with biopsy-proven IP with lateral frontal sinus extension underwent a combined endonasal and transpalpebral approach for tumor resection.

Patient demographic data, preoperative characteristics, imaging, and follow-up data were compiled through retrospective chart review. Patients were selected for this approach when the tumor extended to the posterior frontal sinus wall, lateral frontal sinus recess, and orbit. Tumors were first approached endonasally until the frontal recess was reached. A Draf IIB or Draf III procedure was then performed to gain better exposure. Orbitofrontal exposure was achieved through an upper eyelid incision. Miniorbitofrontal craniotomy window was designed based on tumor location. Resection of the frontal and orbital extension was enhanced by endoscopic-assisted dissection through the orbitofrontal window.

Results

The transpalpebral approach provided access to all walls of the ipsilateral frontal sinus, the intersinus septum, and the medial aspect of the contralateral sinus. Complete tumor resection was achieved in all patients. There were no orbital complications, no visible eyelid asymmetry or scarring, and all patients had preserved forehead sensation. There were no recurrences on follow-up.

Conclusion

Combining a transpalpebral orbitofrontal craniotomy with the endonasal approach allows complete resection of invasive IP with extension into the frontal sinus. This is achieved with great cosmetic results.

Level of Evidence

4. Laryngoscope, 2017

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Investigating hyperventilation syndrome in patients suffering from empty nose syndrome

Objectives/Hypothesis

Patients with empty nose syndrome (ENS) following turbinate surgery often complain about breathing difficulties. We set out to determine if dyspnea in patients with ENS was associated with hyperventilation syndrome (HVS). We hypothesized that lower airway symptoms in ENS could be explained by HVS.

Study Design

Observational prospective study.

Methods

All consecutive patients referred to our center for ENS over 1 year were invited to participate. Patients completed the Nijmegen score and underwent a hyperventilation provocation test (HVPT) and arterial blood gas and cardiopulmonary tests. HVS was defined by a delayed return of the end-tidal partial pressure of carbon dioxide in the expired gas to baseline during HVPT. Patients with HVS were asked to complete the Sinonasal Outcome Test (SNOT)-16 questionnaire before and after a specific eight-session respiratory rehabilitation program.

Results

Twenty-two of the 29 patients referred for ENS during the study period were eligible for inclusion and underwent a complete workup. HVS was diagnosed in 17 of these patients (77.3%). In the five patients who completed the SNOT-16, the score was significantly lower after rehabilitation.

Conclusions

This study suggests that HVS is frequent in patients with ENS, and that symptoms can be improved by respiratory rehabilitation. Pathophysiological links between ENS and HVS deserve to be further explored.

Level of Evidence

2b Laryngoscope, 2017

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Prevertebral muscle flap for internal carotid artery coverage during oropharyngeal transoral surgery

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Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training

Objectives/Hypothesis

To compare the effectiveness of massed versus interval training when teaching otolaryngology residents microvascular suturing on a validated microsurgical model.

Study Design

Otolaryngology residents were placed into interval (n = 7) or massed (n = 7) training groups. The interval group performed three separate 30-minute practice sessions separated by at least 1 week, and the massed group performed a single 90-minute practice session. Both groups viewed a video demonstration and recorded a pretest prior to the first training session. A post-test was administered following the last practice session.

Methods

At an academic medical center, 14 otolaryngology residents were assigned using stratified randomization to interval or massed training. Blinded evaluators graded performance using a validated microvascular Objective Structured Assessment of Technical Skill tool. The tool is comprised of two major components: task-specific score (TSS) and global rating scale (GRS). Participants also received pre- and poststudy surveys to compare subjective confidence in multiple aspects of microvascular skill acquisition.

Results

Overall, all residents showed increased TSS and GRS on post- versus pretest. After completion of training, the interval group had a statistically significant increase in both TSS and GRS, whereas the massed group's increase was not significant. Residents in both groups reported significantly increased levels of confidence after completion of the study.

Conclusions

Self-directed learning using a chicken thigh artery model may benefit microsurgical skills, competence, and confidence for resident surgeons. Interval training results in significant improvement in early development of microvascular anastomosis skills, whereas massed training does not.

Level of Evidence

NA Laryngoscope, 2017

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Nasopharyngeal papillomas treated with CO2 laser and human papillomavirus vaccination

This case report describes the use of CO2 laser and quadrivalent human papillomavirus (HPV) vaccination in two patients with nasopharyngeal HPV11-positive recurrent respiratory papillomas (RRP). These patients initially underwent CO2 laser excision but developed recurrent lesions and underwent HPV vaccination as adjunct therapy. The recurrent lesions shrank after vaccination and were again excised with CO2 laser. Subsequently, these patients had no recurrence of lesions on long-term follow-up at 33 months or 6 years after surgery. Thus, in patients with nasopharyngeal RRP, resection with CO2 laser, and HPV vaccination as adjunct therapy should be considered in HPV11-associated cases. Laryngoscope, 2017

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In response to “In reference to endoscopic-assisted transmastoid decompression of petrous apex cholesterol granuloma”

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Successful ablation of plunging ranula by ultrasound-guided percutaneous ethanol injection

Evidence supporting any one treatment for plunging ranula is limited. Standard treatment—complete excision of the sublingual gland and ranula—is invasive and morbid given the close operative proximity to the submandibular duct and lingual nerve. OK-432 (Picibanil; Chugai Pharmaceutical Co., Tokyo, Japan) sclerotherapy has been studied as a less invasive treatment but is inaccessible in the United States. This report illustrates the successful management of a plunging ranula using ultrasound-guided percutaneous ethanol injection. Within 2 months of the procedure, the patient had complete resolution of the plunging ranula, with no associated side effects. We propose that ultrasound-guided percutaneous ethanol injection be considered for the management of plunging ranula. Laryngoscope, 2016

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A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures

Objectives

Currently, there are no cardiovascular (CV) preprocedure screening parameters for patients undergoing in-office laryngeal procedures (IOLP). Studies have shown significant changes in CV measures for IOLP. The aim was to develop and evaluate a pre-IOLP CV screening protocol.

Methods

Review of IOLP literature and consultation with an anesthesiologist and cardiologist led to the development of CV parameters and questions related to four metabolic equivalents (METS) of work as a patient-screening tool before IOLP. A separate cohort was screened with only a modified CV protocol. All patients were screened for heart rate (HR) and blood pressure (BP) elevation prior to the procedure. Need for further CV evaluation was characterized as systolic blood pressure BP >160, diastolic BP >100, and/or HR >110 beats/minute. Patients whose BP/HR exceeded these values were referred to their primary care physician (PCP) before re-screening. If parameters were exceeded again at the second screen, then the procedure was done under monitored anesthesia care.

Results

The first study phase included 56 patients. The fail rate was 40% largely related to four METS of work. The second study phase included 440 patients. The screen fail rate was 15 patients of 572 (2.6%). Of these, 12 patients of 132 (9.1%) failed the initial screen and were sent to their PCP for further evaluation, and five of 440 (1.4%) patients failed on the day of the procedure. Overall, five of 440 (1.5%) patients would qualify to have their site of service changed for their laryngology procedure from an unmonitored to a monitored setting due to the prescreening criteria.

Conclusion

Few patients needed further workup based upon the in-office CV parameters set in this study. Patients with CV risk factors were identified by the screening protocol. Having established hemodynamic parameters in place may improve the safety of IOLP with a very low physician burden.

Level of Evidence

2b Laryngoscope, 2017

http://ift.tt/2o9KT89

PET/CT-directed Hyperfractionated Radiation Dose Escalation in Esophageal Cancer

Condition: Esophageal Cancer
Interventions: Radiation: radiochemotherapy 1; Radiation: radiochemotherapy 2; Radiation: radiochemotherapy 3; Radiation: radiochemotherapy 4; Radiation: radiochemotherapy 5; Radiation: radiochemotherapy 6
Sponsor: Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Recruiting - verified April 2017

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Neck Drains for SLNDs

Condition: Neck Disease, Head and Neck Cancer
Intervention: Procedure: remove drain
Sponsor: University of California, San Francisco
Recruiting - verified April 2017

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Effect of Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules on Oral Mucositis in Nasopharyngeal Carcinoma Patients Receiving Radiotherapy.

Conditions: Oral Mucositis; Quality of Life
Intervention: Other: Lactobacillus, Bifidobacterium and Enterococcus
Sponsor: Jiangxi Provincial Cancer Hospital
Recruiting - verified April 2017

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Is perioperative administration of 5% dextrose effective in reducing the incidence of PONV in laparoscopic cholecystectomy?: A randomized control trial

To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy.

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Automated anesthesia carts reduce drug recording errors in medication administrations — A single center study in the largest tertiary referral hospital in China

To clinically evaluate a type of patented automated anesthesia cart in medication administrations in anesthesia.

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Efficacy of prophylactic doses of intravenous nitroglycerin in preventing myocardial ischemia under general anesthesia: A systematic review and meta-analysis with trial sequential analysis

To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia.

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Scheduling non-operating room anesthesia cases in endoscopy: Using the sandbox analogy

For many hospitals, the non-operating room anesthesia (NORA) workload continues to expand. We developed a new NORA scheduling process with shared block time – a sandbox - amongst all of the gastroenterology groups and measured the efficacy of the intervention using basic operating room management metrics.

http://ift.tt/2pcClhN

Interpathologist concordance in the histological diagnosis of focal prostatic atrophy lesions, acute and chronic prostatitis, PIN, and prostate cancer

Abstract

Epidemiological and biological evidence indicates a causal relationship between the presence of proliferative atrophic lesions and the development of prostatic intraepithelial neoplasia (PIN) and prostate cancer. The presence of inflammatory and atrophic lesions of the prostate is widely underestimated and they are not generally mentioned in pathology reports. We performed a histopathological concordance study among eight genitourinary specialists and seven generalist pathologists, using 116 histological slides of prostate lesions, including proliferative atrophic lesions, PIN, and cancer. The overall agreement between all possible pairs of reviewers was 80% for prostate cancer, 67% for PIN, and 49% for proliferative atrophic lesions. When using as gold standard the assessment of a single genitourinary pathologist, the mean agreement percentage increased to 97% for prostate cancer, 92% for PIN, and 72% for proliferative atrophic lesions.

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Computational fluid dynamics study of the pharyngeal airway space before and after mandibular setback surgery in patients with mandibular prognathism

Publication date: Available online 12 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Yajima, M. Oshima, T. Iwai, H. Kitajima, S. Omura, I. Tohnai
The purpose of this study was to investigate the relationship between the pressure drop in the pharyngeal airway space (ΔPPAS) and the minimum cross-sectional area (minCSA) of the pharyngeal airway before and after mandibular setback surgery using computational fluid dynamics, in order to prevent iatrogenic obstructive sleep apnoea. Eleven patients with mandibular prognathism underwent bilateral sagittal split osteotomy for mandibular setback. Three-dimensional models of the upper airway were reconstructed from preoperative and postoperative computed tomography images, and simulations were performed using computational fluid dynamics. ΔPPAS and the minCSA of the pharyngeal airway were calculated, and the relationship between them was evaluated by non-linear regression analysis. In all cases, the minCSA was found at the level of the velopharynx. After surgery, ΔPPAS increased significantly and the minCSA decreased significantly. The non-linear regression equation expressing the relationship between these variables was ΔPPAS=3.73×minCSA^−2.06. When the minCSA was <1cm², ΔPPAS increased greatly. The results of this study suggest that surgeons should consider bimaxillary orthognathic surgery rather than mandibular setback surgery to prevent the development of iatrogenic obstructive sleep apnoea when correcting a skeletal class III malocclusion.

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The autogenous graft versus transport distraction osteogenesis for reconstruction of the ramus–condyle unit: a prospective comparative study

Publication date: Available online 12 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Kohli, S. Mohanty, S. Singh, Sandeep, J. Dabas, R. Patel
This study aimed to compare the joint function and morphology achieved following condylar reconstruction using sternoclavicular grafts (SCG) versus transport distraction osteogenesis (TDO) in temporomandibular joint (TMJ) ankylosis patients. Twenty-two patients with TMJ ankylosis underwent TMJ reconstruction with SCG or TDO (n=11 each). Radiographic and clinical evaluations were performed at 1 week and at 1, 3, and 6 months post-surgery. Clinical criteria examined included the duration of surgery, mean postoperative mouth opening, excursive jaw movements, and pain scores. The radiographic evaluation 6 months postoperatively (computed tomography) included subjective assessment of joint morphology and measurements of the mean condylar height, width achieved, and amount of condylar resorption. The χ² test and Student t-test were used to compare qualitative and quantitative variables, respectively. Similar mean mouth opening (SCG=31.8mm, TDO=32.1mm at 6 months), excursive movements, and pain scores were observed in the two groups throughout follow-up. Mean condylar resorption was significantly greater in the TDO group (TDO=7.0mm, SCG=2.7mm; P=0.005). The duration of reconstruction surgery was greater in the SCG group (P=0.035). A greater incidence of complications was observed with TDO. In conclusion, based on the protocols used in this study, SCGs are superior to TDO in terms of condylar morphology, stability, and surgical safety.

http://ift.tt/2px6ZS6

Maxilla reconstruction with autogenous bone block grafts: computed tomography evaluation and implant survival in a 5-year retrospective study

Publication date: Available online 12 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.L. Gulinelli, R.A. Dutra, H.F. Marão, S.F.P. Simeão, G.B. Groli Klein, P.L. Santos
This retrospective study was performed to evaluate the bone thickness of the anterior maxillary region after reconstruction with autogenous bone blocks at 6 months and 5 years after surgery using computed tomography (CT) and to determine the implant survival rate. Eleven patients with a horizontal bone deficiency were treated with reconstructive procedures and implant placement. CT measurements were obtained before surgery (T0) and at 6 months (T1) and 5 years (T2) after surgery. The values were analysed statistically (analysis of variance and Tukey's test; P<0.05). Implant survival was evaluated at follow-up. The mean width of the lower region of the ridge (±standard deviation, in millimetres) was 3.8±1.6 at T0, 7.0±1.6 at T1, and 6.5±1.0 at T2; the mean width of the upper region of the ridge was 5.7±2.3 at T0, 8.3±2.2 at T1, and 7.3±1.6 at T2. The mean total thickness of the ridge was 4.7mm at T0, 7.6mm at T1, and 6.9mm at T2; the average increase in horizontal thickness was 2.9mm at T1 and 2.2mm at T2. A statistically significant difference was observed in the mean width of the lower portion at T1 and T2 compared to the width at T0. The implant survival rate was 94.1%. This technique demonstrated high predictability for implant survival, with a reduction in the graft bone during the follow-up period.

http://ift.tt/2or4RfC

Firm, ulcerated nodule with peripheral scale on the arm

A 46-year-old previously healthy woman originally presented to the dermatology clinic for a full skin examination and was incidentally noted to have a nodule on her right arm. The patient stated that the lesion had been present for several months and began as a small pink papule that had been slowly increasing in size. She denied any itching, tenderness, pain, or bleeding. The physical examination revealed a 1.0-cm firm, ulcerated pink nodule with peripheral scale on the right proximal arm (Fig 1).

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CME examination

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April iotaderma (#278)

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Information for Readers

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Who wrote this paper? The ethical issues of authorship

Authorship of scientific manuscripts and publishing new information is fundamental to academic medicine. Furthermore, publications are tied to academic promotion, professional recognition, or monetary rewards, such as bonuses or securing of research funds. Unfortunately this demand for publication can put tremendous pressure on researchers and academic physicians, which can lead to corner cutting, inappropriate behavior, and undeserved authorship.1 Research often involves many members of an intradisciplinary or an interdisciplinary team, not all of whom will fulfill authorship requirements.

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Answers to CME examination

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Comparing the sensitivity of auramine-rhodamine fluorescence to polymerase chain reaction in the detection of Mycobacterium leprae in Fite-negative tissue sections

To the Editor: Twenty-three skin biopsy specimens from 18 patients with leprosy that were Fite-negative but positive by polymerase chain reaction studies were stained with auramine-rhodamine (AR) and examined under a fluorescent microscope. The clinical features and details of armadillo exposure have been described in a separate report. The current study focused on the utility of AR staining in these patients.

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JAAD Case Reports Article List

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Establishment of a dermatology global health outreach and residency partnership program in Guatemala

To the Editor: To improve international health equity, residency programs can build sustainable partnerships beyond global health rotations.1 Heeding this goal, the University of Pennsylvania (Penn) department of dermatology and the Instituto de Dermatología y Cirugia de Piel (INDERMA), a dermatology residency training program near Guatemala City, Guatemala, founded a partnership in 2013. The Penn-INDERMA dermatology educational exchange program was built upon relationships between Penn and Guatemala established by other university departments.

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Progressive hyperpigmented rash in a middle-aged man

A 44-year-old Indian man presented with a 1-year history of a progressive, nonremitting, asymptomatic rash. The physical examination revealed multiple oval-shaped, hyperpigmented macules and patches scattered on his trunk, thighs, and neck (Figs 1 and 2). In addition, papular lesions were seen on his left wrist. He had no oral or nail involvement. His medications included febuxostat and simvastatin, and a trial discontinuation of these medications failed to resolve the rash. A punch biopsy specimen was obtained (Fig 3), and the laboratory work-up, including autoimmune work-up, was negative.

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A survey-based study of management of longitudinal melanonychia amongst attending and resident dermatologists

To the Editor: Subungual melanoma (SM) represents 0.7% to 3.5% of melanoma cases, but often carries a worse prognosis than similarly staged cutaneous melanomas.1-3 While longitudinal melanonychia (LM), a brown-black band of the nail plate, is the most common presenting sign of SM (2/3 of cases), it is not specific for SM.4 In fact, in 1 study, only 6.8% cases of LM showed histologic evidence of SM, with the remaining cases benign etiologies, including subungual hematoma, nail matrix nevus, trauma, nail apparatus lentigo, and melanocytic activation.

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Answers to CME examination

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Lack of efficacy of topical timolol for cutaneous telangiectasias in patients with hereditary hemorrhagic telangiectasia: Results of a pilot study

To the Editor: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant condition that results from mutations in several genes that lead to mucocutaneous telangiectasias and visceral arteriovenous malformations.1 Cutaneous telangiectasias do not usually occur until after puberty and the lesions increase in size and number with time. The lesions can be socially stigmatizing for patients and can bleed with minor trauma.

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Dermatology Calendar

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The use of gentian violet 2% solution to identify holes in the deep margin of tissue excised during Mohs micrographic surgery

Complete Mohs microscopic margin assessment requires excision of intact, contiguous tissue at both the peripheral and deep margins. Integrity of the deep margin may not be possible for deeply invasive tumors that extend to anatomic structures that are difficult to resect under local anesthesia (eg, bone) or whose resection would increase surgical morbidity (eg, tendon) or would benefit from care by other subspecialties. Precisely marking the holes in the soft tissue excision can guide further targeted resection.

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Lower extremity erythema and tightening in an elderly male

A 71-year-old man presented with lower extremity erythema and skin thickening. His medical history included metastatic prostate cancer treated with docetaxel, complicated by treatment-limiting lower extremity edema. He had previously undergone gadolinium-contrasted magnetic resonance imaging and remotely used L-tryptophan. One month after chemotherapy, progressive painful lower extremity tightening and erythema had developed. He denied dysphagia, Raynaud phenomenon symptoms, myalgias, weakness, or renal dysfunction.

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Preventing disruption of surgical dressings in patients with cognitive impairment

Cognitively impaired patients often have a decreased ability to participate in their own healing and may be unable or unwilling to comply with a physician's treatment. They are more likely to pick at a surgical site or peel off dressings, which may result in an increased incidence of postoperative infection.1

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A warning sign of other vascular/skeletal abnormalities

A 2-year-old male (Fig 1) was referred for asymptomatic skin lesions on the lip and neck that had been present since birth. The physical examination revealed the presence of a capillary malformation on the lower lip of deep red color and well-defined frayed edges that exceeded the lip vermilion (Fig 2). He also had a purple-blue rubbery tumor on the anterior aspect of his neck that became more evident with crying. The patient also had mild facial asymmetry with a cranial perimeter in the upper normal limit.

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Surgical staples for hemostasis during scalp surgery

In patients with implanted electrical devices, electrocautery has the potential to burn tissue around the device or to reprogram it; thus, use of bipolar electrocautery is preferred. However, focal use of bipolar electrocautery during scalp reconstruction is usually time-consuming because of the abundant vascularity and the frequent retraction of vessels after the incision, and insufficient hemostasis often results. Optimization of hemostasis is needed in these patients.

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Nail removal in pachyonychia congenita: Patient-reported survey outcomes

To the Editor: Pachyonychia congenita (PC), a genodermatosis characterized by onychodystrophy and painful palmoplantar keratoderma, is caused by mutations in several keratin genes (KRT6A, KRT6B, KRT6C, KRT16, KRT17). The nail dystrophy may cause pain, infection, and functional and psychosocial impairment.1 Prior studies on nail removal are limited.2,3

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Case 11-2017 — A 61-Year-Old Woman with Leg Swelling, Back Pain, and Hydronephrosis

Presentation of Case. Dr. Areej El-Jawahri (Hematology–Oncology): A 61-year-old woman was seen in the emergency department of this hospital because of leg swelling and back pain. The patient had been in her usual health until approximately 3 months before this presentation, when mild swelling of…

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FDA OKs Marketing of Whole Slide Imaging for Digital Pathology

FDA data review found that diagnoses based on digital interpretation were similar to those based on traditional glass slides read by light microscopy.
FDA Approvals

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Demonstration of sympathetic nerve innervation in a patient with takotsubo cardiomyopathy using single-photon emission CT

Description

A 16-year-old male patient with anorexia nervosa was admitted to our hospital because of unconsciousness. He was in hypoglycaemic shock, with a serum glucose level of 40 mg/dL, and recovered consciousness after a venous injection of glucose. The patient's systolic blood pressure remained <70 mm Hg after he recovered consciousness. A 12-lead ECG showed Q waves and ST segment elevation in the precordial leads, and echocardiography showed hypokinesis of the midventricle and apex. Next, we performed coronary angiography, which revealed the absence of stenosis of the coronary arteries. Left ventriculography showed findings typical of takotsubo cardiomyopathy, apical ballooning with akinesis of the midventricle and apex and hyperkinetic basal segments (figure 1). 201Tl and iodofiltic acid (123)I-dual cardiac single-photon emission CT (SPECT) (figure 2A,B) at 1 week showed the absence of perfusion defect and fatty acid metabolism abnormality at the apex. Metaiodobenzylguanidine cardiac SPECT (figure 2C)...

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Rectus sheath haematoma: a rare masquerader for abdominal pain

Rectus sheath haematoma is a rare cause of abdominal pain. It can be easily confused for other causes of acute abdomen and may even lead to unnecessary laparotomies. Our patient has the rectus sheath haematoma because of violent coughing and on presentation had no obvious clinical sign pointing to the same. Diagnosis was made by a CT scan of the abdomen, and patient was treated conservatively. Rectus sheath haematomas are usually present on the posterior aspect of the rectus muscles and thus may not be clinically appreciable.

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Postpartum tubo-ovarian abscess, likely arising from pelvic inflammatory disease during pregnancy

Description

A female aged 18 years presented 2 weeks postnormal vaginal delivery with worsening generalised abdominal pain radiating to the back since delivery, with associated night sweats. She was vomiting, had loose bowel motions and had difficulty passing urine, but denied dysuria. On examination, she was febrile, tachypnoeic and tachycardic, and had a pale complexion. Her abdomen was distended with maximal tenderness in the left illiac fossa and associated rebound and percussion tenderness. She was unable to pass urine in the emergency department. Blood tests demonstrated a raised white cell count, C reactive protein 344 and CA-125 145.

She had a CT abdomen which showed a large pelvic abscess (figure 1 and figure 2) with internal septations posterior to the uterus (figure 3) and bilateral hydronephrosis and hydroureter. She was given intravenous antibiotics and underwent a laparotomy with drainage of pelvic abscess. Intraoperative findings included...

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Serum Cytokine Profile in a Patient Diagnosed with Dysferlinopathy

Limb-girdle muscular dystrophy type 2 (LGMD2B) is a mild form of dysferlinopathy, characterized by limb weakness and wasting. It is an autosomal recessive disease, with currently 140 mutations in the LGMD2B gene identified. Lack of functional dysferlin inhibits muscle fiber regeneration in voluntary muscles, the main pathological finding in LGMD2B patients. However, the immune system has been suggested to contribute to muscle cell death and tissue regeneration. Serum levels of 27 cytokines were evaluated in a dysferlinopathy patient. Levels of 8 cytokines differed in patient serum compared to controls. Five cytokines (IL-10, IL-17, CCL2, CXCL10, and G-CSF) were higher while 3 were lower in the patient than in controls (IL-2, IL-8, and CCL11). Together, these data on serum cytokine profile of this dysferlinopathy patient suggest immune response activation, which could explain leukocyte infiltration in the muscle tissue.

http://ift.tt/2p9Bilu

Polymyalgia rheumatica and vagal paraganglioma

Publication date: Available online 12 April 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): V. L'Huillier, O. Mauvais, S. Valmary-Degano, L. Tavernier
IntroductionVagal paraganglioma are rare tumors that are mostly asymptomatic. We report a case of vagal paraganglioma associated with paraneoplastic polymyalgia rheumatica and review the literature on benign paragangliomas of the head and neck associated with paraneoplastic syndrome.Case reportA 53-year-old man presented with atypical polymyalgia rheumatica. MRI revealed a tumor that was then surgically excised. Histological examination confirmed the diagnosis of benign vagal paraganglioma. Rapid, complete and permanent resolution of all rheumatological symptoms were observed postoperatively, confirming the diagnosis of paraneoplastic polymyalgia rheumatica.ConclusionParaganglioma of the neck associated with paraneoplastic syndrome remains exceptional. A predisposing gene mutation must be systematically investigated. Long-term surveillance must be ensured due to the risk of local recurrence, second tumors or metastasis.

http://ift.tt/2p9xyAk

A rare tumor of the auricle

Publication date: Available online 12 April 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M.V. Akdoğan, O. Topal, H. Erinanç

http://ift.tt/2o9ZK1v

Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth

Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.

http://ift.tt/2oCljM9

Role of the Ubiquitin C-Terminal Hydrolase L1-Modulated Ubiquitin Proteasome System in Auditory Cortex Senescence

Background/Aims: According to recent studies, central auditory impairments are closely related to neurodegenerative diseases. However, the mechanism of central presbycusis remains unclear. Ubiquitin C-terminal hydrolase L1 (UCHL1) is important in maintaining proteasomal activity; however, the detailed mechanism has not yet been fully elucidated. This study aims to investigate the molecular alterations involved in UCHL1 regulation during auditory cortex aging. Methods:D-Galactose (D-gal) induces oxidative stress and senescence in the auditory cortex, as reported in our previous studies. Primary auditory cortex cells were treated with D-gal for 72 h or 5 days. The proteins related to the ubiquitin proteasome system (UPS) and proteasomal activities were evaluated. UCHL1 was overexpressed, and the effects of UCHL1 on the UPS and proteasomal activity were analyzed. Results: Proteasomal activity was elevated at 72 h and decreased at 5 days in D-gal-treated primary auditory cortex cells. We also found that overexpression of UCHL1 increased the UPS-related proteins UBE1, PSMA7, ubiquitinated proteins, and monoubiquitin, and proteasomal activity. Conclusion: The results suggest that UCHL1 may modify the aging process in the auditory cortex by regulating UPS- related proteins.
ORL 2017;79:153-163

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An update of common autosomal recessive non-syndromic hearing loss genes in Iranian population

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Tohid Ghasemnejad, Mahmoud Shekari Khaniani, Fatemeh Zarei, Mina Farbodnia, Sima Mansoori Derakhsahan
Autosomal-recessive genes are responsible for about 80% of the hereditary non-syndromic hearing loss (NSHL) cases. In Iran, due to consanguineous marriages, NSHL is the second most frequent disability after intellectual disability, occurring one in 16 individuals. Enormous heterogeneity in the genetic pathology of hearing loss causes a major challenge in identification of responsible genes. In Iran, GJB2 is responsible for the most cases of pre-lingual and non-syndromic hearing loss (with frequency of 16.7%) which followed by other genes with lower frequency. Although several studies have indicated that a large proportion of both syndromic and non-syndromic hearing loss in Iranian populations are caused by defects in just a few genes, new detection strategies such as NGS (Next-generation sequencing) have increased the spectrum of responsible mutations. However, by applying this technique in Iran patients screening, the role of lots of novel related genes have been reported. In this review, we aim to describe function of these genes and their contribution to non-syndromic genetic hearing loss in Iranian population and we classify the genes by their functions.

http://ift.tt/2ouSDUR

Laryngotracheal anomalies and airway fluoroscopy in infants

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Amal Isaiah, Kevin D. Pereira
ObjectivesThe role of airway fluoroscopy in the diagnosis of laryngotracheal anomalies in infants is controversial. We aimed to (i) compare airway fluoroscopic characteristics with endoscopic findings in infants presenting for evaluation of upper airway obstruction and (ii) assess the as low as is reasonably achievable (ALARA) status for airway fluoroscopy as an initial diagnostic test in suspected laryngotracheal anomalies.Materials and methodsWe performed a retrospective review of children who underwent fluoroscopy and endoscopic evaluation of the airway in the operating room for suspected laryngotracheal anatomic abnormalities. Thirty-four infants who underwent both procedures at a tertiary level university-based children's hospital from January 1, 2008 to December 1, 2013 were included. Infants with suspected foreign bodies or an existing tracheostomy were excluded. Intraoperative findings from endoscopy and radiologic interpretation from fluoroscopy were compared using standard tools for validation of a diagnostic test. These metrics were compared with historic data that suggested good correlation between radiologic and endoscopic findings in older children.ResultsThe median age was 3.6 months (range 1–8 months). The sensitivity of airway fluoroscopy for determining laryngotracheal pathology was 18%. Specificity, positive predictive value and negative predictive value were 83%, 67% and 35%, respectively. Although each fluoroscopic exposure was optimized for pediatric patients, the median cumulative exposure to ionizing radiation was 19 mR (range 10–34 mR).ConclusionsAirway fluoroscopy yields metrics that are overall poor to be considered a valid and accurate universal radiologic diagnostic test in infants evaluated for laryngotracheal pathology. The cumulative exposure to ionizing radiation from use of a fluoroscope cannot be justified by the sensitivity of the test and may not conform to ALARA standards for imaging in this population.

http://ift.tt/2pwq9rm

Effect of the external nasal dilator on adolescent athleteswith and without allergic rhinitis

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Ricardo Reis Dinardi, Cláudia Ribeiro de Andrade, Cássio da Cunha Ibiapina
ObjectivesThe ability to effectively breathe through the nose is an important component of physical exercise. The goal of this study is to evaluate the effect of the external nasal dilator (END) on healthy adolescent athletes and those with allergic rhinitis.MethodsClinical trial, double-blind, crossover, in which we evaluated healthy adolescent athletes with allergic rhinitis, using experimental and placebo ENDs, submitted to a maximum cardio-respiratory test in randomized order. Predicted values for peak nasal inspiratory flow (PNIF%) and nasal resistance (NR) were obtained, and the rating of perceived exertion (RPE) was also assessed after the race test.Results65 adolescents participated in the study, 30 of whom had allergic rhinitis. The use of experimental ENDs demonstrated a statistically significant improvement in peak nasal inspiratory flow values (predicted %), nasal resistance, maximal oxygen uptake value (VO2Max.) and rating of perceived exertion, both in the healthy group and the one with allergic rhinitis.ConclusionResults suggested that END reduces nasal resistance, improves maximal oxygen uptake and rating of perceived exertion after a maximum cardio-respiratory test on healthy adolescents and those with allergic rhinitis.

http://ift.tt/2ouJUSo

Clinical Experience on Hearing Screening in Twins and Triplets: A Retrospective Study

Abstract

Twin or multiple pregnancies often have neonatal complications. Common complications include low birth weight, respiratory distress, neonatal intensive care unit (NICU) admission (>5 days) and low APGAR score especially on second twin. (1) To compare referral rates of newborn hearing screening in twins and triplets between risk and non-risk babies for hearing loss, (2) to determine the effects of birth order on referral rates in twins and triplets. A retrospective study was carried out from the case records of the neonates enrolled in the referral based NICU hearing screening program during April 2013 to December 2014 at Institute of Obstetrics and Gynecology, Chennai. 1405 neonates (723 males and 682 females) in the age range of 3–28 days were screened during this period among which 76 were twins (38 pairs) and 9 were triplets (3 sets). We classified them further into non risk and risk babies among twins according to the Joint Committee for Infant Hearing (JCIH) recommendations. A dual step hearing screening protocol was used to screen the neonates. They were initially tested with distortion product otoacoustic emission (DPOAE) then with automated auditory brainstem response (AABR) before discharged from the hospital. Out of 76 (100%) twin babies 43 (56.58%) babies had one or more risk factors for hearing loss. Most common risk factors were low birth weight, premature birth, mechanical ventilation >5 days, hyperbilirubinemia, infections, ototoxic medications and family history of hearing loss. Each risk factor was observed in equal proportion in 1st born and 2nd born twins. 12 (15.76%) risk babies and 11 (14.47%) non risk babies failed in DPOAE testing. Out of 9 triplets babies (3 set) 3 babies had risk factors for hearing loss. One baby in 2nd born babies group failed AABR screening. Referral rates were slightly higher in 2nd born twins when compared to 1st born twins in DPOAE testing. Chi square test did not reveal any significant association between referral rates with risk factors and birth order (p > 0.05). The referral rates in twins are higher than the total population screened. There is some influence of birth order on the referral rates in twins. It needs to be further investigated on larger population.

http://ift.tt/2o9loDe

Pseudoepitheliomatous keratotic and micaceous balanitis treated with topical 5-fluorouracil and liquid nitrogen

Summary

Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is an uncommon premalignant condition involving the glans penis. We report the case of an 86-year-old man who presented with phimosis and pain on retracting his foreskin. He had previously undergone circumcision, which revealed a hyperkeratotic plaque with thin mica-like scales involving his glans penis. Histology of the lesion showed hyperkeratosis, parakeratosis, epidermal acanthosis and papillomatosis with no evidence of dysplasia. Immunohistochemistry for human papillomavirus was negative. The patient was treated with topical 5-fluorouracil and liquid nitrogen with clinical improvement. He is now under long-term surveillance for verrucous carcinoma and squamous cell carcinoma.

http://ift.tt/2p9ixhU

Severe Asthma: differential chemokine response of airway epithelial cells

Publication date: Available online 12 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Biju Thomas, Robert Anthony Hirst, Mina H Brett-Pitt, Gwyneth Williams, Peter W. Andrew, Ana R. Sousa, Richard P. Marshall, Chrostopher Brightling, Christopher O'Callaghan
The differential chemokine response of airway basal cells of severe asthma patients to Streptococcus pneumoniae and Dermatophagoides pteronyssinus allergen may be of significance in the context of developing novel immunomodulatory therapeutic strategies for atopic asthma.

http://ift.tt/2nHojHN

Water-soluble chitosan inhibits nerve growth factor and attenuates allergic inflammation in mite allergen-induced allergic rhinitis

Publication date: Available online 12 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Pei-Chi Chen, Miao-His Hsieh, PhD. Wen-ShuoKuo, Hui-Fan Kao, Chih-Li Hsu, Jiu-Yao Wang

Teaser

Nerve growth factor induces nasal inflammation by augmenting the existing TH2 immune response, and this can be suppressed bywater-soluble chitosan, a natural, nontoxic product that provides new therapy for allergic rhinitis.

http://ift.tt/2pwwH9u

Adhesion-induced eosinophil cytolysis requires the RIPK3-MLKL signaling pathway which is counter-regulated by autophagy

Publication date: Available online 12 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Susanne Radonjic-Hoesli, Xiaoliang Wang, Elisabeth de Graauw, Christina Stoeckle, Beata Styp-Rekowska, Ruslan Hlushchuk, Dagmar Simon, Peter J. Spaeth, Shida Yousefi, Hans-Uwe Simon
BackgroundEosinophils are a subset of granulocytes which can be involved in the pathogenesis of different diseases, including allergy. Their effector functions are closely linked to their cytotoxic granule proteins. The release takes place by several different mechanisms, one of which is cytolysis, which is associated with the release of intact granules, so-called clusters of free eosinophil granules. The mechanism underlying this activation-induced form of cell death in eosinophils has remained unclear.ObjectiveWe aimed to elucidate the molecular mechanism of eosinophil cytolysis.MethodsIsolated blood eosinophils were incubated on glass cover slips coated with intravenous immunoglobulin (IVIG) and inactive complement component 3b (iC3b). A morphological characterization of the distinct stages of the proposed cascade was addressed by means of time-lapse automated fluorescence microscopy, electron microscopy, and immunohistochemistry. Experiments with pharmacological inhibitors were performed to elucidate the sequence of events within the cascade. Tissue samples of patients suffering from eosinophilic skin diseases or eosinophilic esophagitis were used for in vivo analyses.ResultsFollowing eosinophil adhesion, we observed reactive oxygen species (ROS) production, early degranulation, and granule fusion processes leading to a distinct morphology exhibiting cytoplasmic vacuolization and, finally, to cytolysis. Using a pharmacological approach, we demonstrate the presence of a receptor-interacting protein kinase 3 (RIPK3) – mixed lineage kinase-like (MLKL) signaling pathway in eosinophils, which, following its activation, leads to the production of high levels of reactive oxygen species (ROS) in a p38 mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3'-kinase (PI3K) - dependent manner. All these steps are required for cytoplasmic vacuolization and subsequent cytolysis to occur. Interestingly, triggering cytolysis is associated with an induction of autophagy in eosinophils and additional stimulation of autophagy by pharmacological inhibition of the mechanistic target of rapamycin (mTOR) counter-regulates cell death. Moreover, MLKL phosphorylation, cytoplasmic vacuolization, and cytolysis were observed in eosinophils under in vivo inflammatory conditions.ConclusionWe report that adhesion-induced eosinophil cytolysis takes place by a RIPK3-MLKL-dependent necroptosis which can be counter-regulated by autophagy.The receptor-interacting protein kinase 3 (RIPK3) - mixed lineage kinase-like (MLKL) signaling pathway mediates eosinophil cytolysis, a phenomenon often observed in eosinophilic tissues of patients suffering from diseases with eosinophil-mediated immunopathology.

Teaser

Capsule Summary

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Diminished airway macrophage expression of the Axl receptor tyrosine kinase is associated with defective efferocytosis in asthma.

Publication date: Available online 12 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Aleksander M. Grabiec, Nicholas Denny, John A. Doherty, Kaisa E. Happonen, Jenny Hankinson, Emma Connolly, Mark E. Fife, Toshifumi Fujimori, Naoya Fujino, Anu Goenka, Susan Holden, Gaël Tavernier, Rajesh Shah, Peter C. Cook, Andrew S. MacDonald, Robert M. Niven, Björn Dahlbäck, Stephen J. Fowler, Angela Simpson, Tracy Hussell

Teaser

The apoptotic cell recognition receptor Axl is highly expressed on human airway/alveolar macrophages, its expression is driven by the lung microenvironment and is significantly reduced in asthma, which may explain defects in apoptotic cell clearance.

http://ift.tt/2pwCCLw

Comparison of topical ropivacaine with and without ketamine on post-surgical pain in children undergoing tonsillectomy: a randomized controlled double-blind study

Abstract

Purpose

Tonsillectomy in pediatric patients may cause severe postoperative pain. Topical local anesthetics are an easy and safe way to control post-tonsillectomy pain, but there is no benefit during the early postoperative stage. Topical ketamine shows a good effect on early stage postoperative pain. We compared the effect of topical ropivacaine with and without ketamine on post-tonsillectomy pain.

Methods

Patients aged 3–7 years undergoing tonsillectomy were selected to participate in the study. Our study was performed in a randomized, placebo-controlled, double-blind manner. Patients were randomly assigned to one of two groups using computer-generated random numbers. The researchers who assessed the pain score, the caregivers, and the patient were blinded to group assignment. One group received topical ropivacaine with saline (RS group) and the other group received topical ropivacaine with 20 mg ketamine (RK group) on the tonsillar bed. Pain scores using the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at 15 min and 30 min, and at 1, 2, 4, 8, 16 and 24 h were recorded. Rescue analgesic requirement and complications were also recorded.

Results

A total of 66 patients were randomly assigned to the RS group (n = 33) and the RK group (n = 33). The mCHEOPS scores were significantly lower in the RK group at 15 min (P = 0.046). The mCHEOPS scores of the two groups decreased with time, but there was no intergroup interaction. The RS group received more analgesics until 1 h after surgery and the RK group received more analgesics during 1–24 h after surgery. There were no differences in adverse outcomes.

Conclusions

Topical ropivacaine with ketamine can reduce immediate postoperative pain and analgesic requirement better than ropivacaine alone.

http://ift.tt/2pbtFIk

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

Patients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression ...

http://ift.tt/2pw9Fzt

Pre-existing chronic interstitial pneumonia is a poor prognostic factor of Goodpasture’s syndrome: a case report and review of the literature

Goodpasture's syndrome is a rare disease that is characterized by rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage.

http://ift.tt/2nHr4J0

Platypnea-orthodeoxia syndrome in the right lateral decubitus position: a case report

Platypnea-orthodeoxia syndrome is a rare syndrome characterized by dyspnea and hypoxia when the patient is sitting or standing. Here we report a case of platypnea-orthodeoxia syndrome caused by a right hemidia...

http://ift.tt/2pwtV43

Updated review of genetic reticulate pigmentary disorders

Abstract

Reticulate pigmentary disorders are a group of disorders characterized by hyperpigmented and/or hypopigmented macules with varying sizes and amounts of pigment. Some of the disorders are heritable, such as Dowling-Degos disease, dyschromatosis universalis hereditaria, dyschromatosis symmetrica hereditaria and reticulate acropigmentation of Kitamura. Although, each condition possesses unique phenotypic characteristics and the prognosis for each is somewhat different, these disorders are highly overlapped and difficult to differentiate in the clinical setting. This updated review provides a clinical and molecular delineation of these genetic reticulate pigmentary disorders and aims to establish a concise diagnostic strategy to allow clinical dermatologists to make an accurate diagnosis, as well as provide useful information for clinical and genetic counselling.

http://ift.tt/2pbgyqI

Internalized stigma in psoriasis: A multicenter study

Abstract

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

http://ift.tt/2o9q5N4

Retrospective evaluation of factors influencing successful skin grafting for patients with skin cancer of the foot

Abstract

Skin grafting is a simple method for reconstruction of a large defect on the foot. Although skin grafting on the foot sometimes fails, it is not clear what factors influence the success rate of skin grafting. We analyzed data for 71 patients with skin cancer of the foot who underwent reconstruction of defects with skin grafting. The factors we evaluated were success rate of skin grafting, weight-bearing or non-weight-bearing area, immediate or delayed reconstruction, and whether a tie-over bolster was used or not. The success rates were higher in patients with lesions in non-weight-bearing areas than in patients with lesions in weight-bearing areas and in patients who underwent delayed reconstruction than in patients who received immediate reconstruction. On the other hand, the use of a tie-over bolster did not improve the success rate. In conclusion, delayed reconstruction is desirable if the lesion is located in a weight-bearing area.

http://ift.tt/2p8OK9i

Modified weekly regimen of cisplatin, epirubicin and paclitaxel induced a durable response in two cases of metastatic extramammary Paget's disease

Abstract

Metastatic extramammary Paget's disease (EMPD) is a rare cancer with no standardized treatment. We report two cases of metastatic EMPD treated with a modified weekly PET (cisplatin, epirubicin and paclitaxel) regimen given biweekly (i.e. 2 weeks on/2 weeks off) that had durable responses. Case 1 was a 74-year-old man with EMPD metastatic to lymph nodes, lung, and bone who presented with a hemorrhagic tumor on the scrotum. We tried the PET regimen weekly, but adjusted the interval to biweekly after two doses because of hematological side-effects. After five doses, he showed a partial response (PR) on imaging, including the bone lesions. The lesions have remained the same size for 1 year. Case 2 was a 65-year-old man with EMPD metastatic to a right inguinal lymph node who presented with an erosive tumor on the scrotum. He was started on weekly docetaxel. However, the lymph node grew and iliac lymph node metastasis developed. Therefore, we tried the PET regimen with a 2 weeks on/2 weeks off schedule. After five doses, he showed a PR. In both cases, all adverse effects were manageable and this modified regimen could be administrated on an outpatient basis. With no current validated chemotherapy regimen, clinicians may consider a modified weekly PET regimen in future treatment of metastatic EMPD.

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Subsequent transepidermal migration of two temporary cardiac pacing wires

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Solitary angiokeratoma presenting as cutaneous horn

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Novel heterozygous mutation, c.74C>G (p.Pro25Arg), in the U2HR gene underlies Marie Unna hereditary hypotrichosis in a Japanese family

http://ift.tt/2p8Wisv

Salivary chromogranin A levels correlate with disease severity but do not reflect anxiety or personality of adult patients with atopic dermatitis

Abstract

Stress-induced scratching is an issue in patients with adult atopic dermatitis (AD). Although itching and stress are believed to be intimately related, no objective index is available; therefore, most evaluations are subjective. Using saliva, which is easily collected, we investigated the degree to which AD severity and patient stress levels are reflected in stress proteins in the saliva. Here, we evaluated the severity (Scoring Atopic Dermatitis [SCORAD] score), stress (State–Trait Anxiety Index [STAI] score), personality (Tokyo University Egogram [TEG] II score) and quality of life (Dermatology Life Quality Index [DLQI] score) of 51 patients with AD who were examined in the Department of Dermatology of Shimane University between April and December 2015. We collected saliva and measured salivary chromogranin A (CgA), amylase and cortisol. The amount of salivary CgA per protein in patients with AD was correlated with their SCORAD score (r = 0.458, P < 0.001). There was no correlation between cortisol or amylase levels and SCORAD score. SCORAD score was correlated with DLQI (r = 0.390, P = 0.006). CgA per protein was correlated with DLQI (r = 0.393, P = 0.004). There was no correlation between scores for the anxiety component of the STAI, TEG II or DLQI. Our results suggested that patients with more severe AD may have high stress levels. The personalities of these patients with AD tended to involve elevated anxiety levels.

http://ift.tt/2o9q3oq

Localized cutaneous immunoglobulin light chain kappa-positive amyloidosis associated with juvenile dermatomyositis

http://ift.tt/2p96DF0

Economic burden of psoriatic patients in Japan: Analysis from a single outpatient clinic

Abstract

Topical and systemic agents have dramatically improved the treatment efficacy of psoriasis. Few reports, however, exist describing the economic burden in Japanese psoriatic patients. The aim of the study was to evaluate the total costs as well as cost versus efficacy of topical and systemic treatments of psoriatic patients under the Japanese health insurance system. The retrospective study was performed from the database of our clinic, which is located in Hokkaido Prefecture. Cost and effectiveness of psoriatic patients were evaluated during the 12-month period from April 2015 to March 2016. Data were collected and calculated for the total cost per year, treatment efficacy and cost versus efficacy. The mean total cost of topical corticosteroid treatment was ¥18 184/year and was lowest among the treatments. The systemic treatment with biologics was most expensive and the costs were over ¥400 000/year. Among the topical treatments, calcipotriol/betamethasone dipropionate was most expensive (¥34 693/year). However, cost versus efficacy was not significantly different from that of topical corticosteroid treatments. The cost of secukinumab was highest among all the treatments (¥631 600/year). However, treatment day per cost was lowest of all the psoriasis treatments. Biologics showed the highest cost than topical or systemic treatments. However, they showed most marked efficacy in terms of improving the psoriatic skin lesions.

http://ift.tt/2o9plrz

Αρχειοθήκη ιστολογίου

Πέμπτη 13 Απριλίου 2017

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