In lasting tribute: Dr James J. Lee (1958-2017)

Publication date: Available online 19 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Helene F. Rosenberg, Elizabeth A. Jacobsen, Bruce S. Bochner, Peter F. Weller




http://ift.tt/2oRUEZB

Issue Information

http://ift.tt/2pUaQZV

Author Index 2017

http://ift.tt/2oNvKw5

Australasian College of Dermatologists Abstracts Presented at the 50th Annual Scientific Meeting 6–9 May 2017 Sydney, New South Wales

http://ift.tt/2pU8nhN

Asthma and risk of coronary heart disease

Publication date: Available online 19 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Huai Liu, Ying Fu, Kunpeng Wang
BackgroundFew studies have investigated the incidence of coronary heart disease (CHD) in patients with asthma, and their results remain inconclusive.ObjectiveTo conduct a meta-analysis to determine whether asthma increases the risk of CHD.MethodsA systematic literature search of the PubMed and Embase databases from inception to August 2016, complemented with references screening of relevant articles and reviews, was performed to identify eligible studies. Only longitudinal cohort studies were included in our meta-analysis.ResultsThe retrieval process yielded 7 studies (12 asthma cohorts) with 495,024 patients. Data pooling across the cohorts revealed that asthma was associated with an increased risk of CHD (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.30–1.57; P < .001), without significant heterogeneity across the studies (I² = 26%, P = .19). This epidemiologic association was more pronounced in female than in male patients (female: HR, 1.50; 95% CI, 1.41–1.59; male: HR, 1.31; 95% CI, 1.16–1.47; P for interaction = .046). In addition, subgroup and sensitivity analyses supported the positive correlation between asthma and incident CHD.ConclusionAsthma is related to an increased incidence of CHD, particularly in women. Clinicians should be aware of this association when faced with a patient with asthma. Further investigations are required to examine how this excess risk should be managed in routine practice.



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Skeletal myositis as the sole feature of relapsing drug reaction with eosinophilia and systemic symptoms syndrome

Publication date: Available online 19 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jennifer Massey, Kishore Kumar, Karl Ng, James Yun, Suran Fernando




http://ift.tt/2pi5XNK

Proptosis and vision loss as grave complications of allergic fungal sinusitis and polyposis

Publication date: Available online 19 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Shane A. Bobart, Ves Dimov, Darby Sider, Esteban Gallego




http://ift.tt/2pTU9gX

Efficacy of Helicobacter pylori eradication therapies in Korea: A systematic review and network meta-analysis

Abstract

Background

The efficacy of Helicobacter pylori eradication regimens may depend on the country where the studies were performed because of the difference in antibiotic resistance. We aimed to analyze the efficacy of H. pylori eradication regimens in Korea where clarithromycin resistance rate is high.

Methods

We searched for all relevant randomized controlled trials published until November 2016 that investigated the efficacy of H. pylori eradication therapies in Korea. A network meta-analysis was performed to calculate the direct and indirect estimates of efficacy among the eradication regimens.

Results

Forty-three studies were identified through a systematic review, of which 34 studies, published since 2005, were included in the meta-analysis. Among 21 included regimens, quinolone-containing sequential therapy for 14 days (ST-Q-14) showed the highest eradication rate (91.4% [95% confidence interval [CI], 86.9%-94.4%] in the intention-to-treat [ITT] analysis). The eradication rate of the conventional triple therapy for 7 days, standard sequential therapy for 10 days, hybrid therapy for 10-14 days, and concomitant therapy for 10-14 days was 71.1% (95% CI, 68.3%-73.7%), 76.2% (95% CI, 72.8%-79.3%), 79.4% (95% CI, 75.5%-82.8%), and 78.3% (95% CI, 75.3%-80.9%), respectively, in the ITT analysis. In the network meta-analysis, ST-Q-14 showed a better comparative efficacy than the conventional triple therapy, standard sequential therapy, hybrid therapy, and concomitant therapy. In addition, tolerability of ST-Q-14 was comparable to those regimens.

Conclusion

In Korea, ST-Q-14 showed the highest efficacy in terms of eradication and a comparable tolerability, compared to the results reported for the conventional triple therapy, standard sequential therapy, hybrid therapy, and concomitant therapy.

http://ift.tt/2phYlLd

Hypothyroidism and Hyponatremia: Rather Coincidence Than Causality

Thyroid , Vol. 0, No. 0.


http://ift.tt/2o6htvx

Racial Disparities In Differentiated Thyroid Cancer: Have We Bridged The Gap?

Thyroid , Vol. 0, No. 0.


http://ift.tt/2op81j3

Garlic Dermatitis on the Neck of an Infant Treated for Nasal Congestion

Abstract

The health benefits of garlic (Allium sativum) as a naturopathic remedy have been well documented, but topical application of garlic has been linked to allergic and irritant contact dermatitis. We present a case of severe irritant contact dermatitis due to application of a fresh garlic necklace to the neck of infant for treatment of nasal congestion.

http://ift.tt/2pTDtX1

“Nails Only” Phenotype and Partial Dominance of p.Glu170Lys Mutation in a Family with Epidermolysis Bullosa Simplex

Abstract

Epidermolysis bullosa (EB) is a heterogeneous group of rare, chronic, inherited skin disorders characterized by marked mechanical fragility of epithelial tissues, with blistering and erosions after minor trauma. We present the first report of a nails-only phenotype in two patients with epidermolysis bullosa simplex (EBS) and a heterozygous pGlu170Lys mutation and the second reported case of EBS associated with a homozygous p.Glu170Lys mutation in the KRT5 gene. Our findings may be relevant for genetic counseling and for understanding the inheritance pattern of EBS.

http://ift.tt/2oXqHt9

Dissecting Cellulitis of the Scalp with Excellent Response to Isotretinoin

Abstract

An 18-year-old man presented for evaluation of a 1-year history of painful nodules on the scalp with associated hair loss. Physical examination revealed multiple confluent, fluctuant, boggy nodules on the scalp with overlying alopecic patches. Based on these findings, a diagnosis of dissecting cellulitis of the scalp was made and the patient was successfully treated with oral isotretinoin therapy.

http://ift.tt/2pTE5Ml

Treatment Update of Chronic Migraine

Abstract

Purpose of Review

Although chronic migraine (CM) is a common disorder that severely impacts patient functioning and quality of life, it is usually underdiagnosed, and treatment responses often remain poor even after diagnosis. In addition, effective treatment options are limited due to the rarity of randomized controlled trials (RCTs) involving patients with CM. In the present review, we discuss updated pharmacological, non-pharmacological, and neurostimulation treatment options for CM.

Recent Findings

Pharmacological treatments include both acute and preventive measures. While acute treatment options are similar between CM and episodic migraine (EM), preventive treatment with topiramate and botulinum toxin A exhibited efficacy in more than two RCTs. In addition, several studies have revealed that behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation techniques are associated with significant improvements in symptoms. Thus, these treatment options are recommended for patients with CM, especially for refractory cases. Neurostimulation procedures, such as occipital stimulation, supraorbital transcutaneous stimulation, non-invasive vagal nerve stimulation, and transcranial direct current stimulation, have shown promising results in the treatment of CM. However, current studies on neurostimulation suffer from small sample size, no replication, or negative results.

Summary

Although CM is less responsive to treatment compared to EM, recent advance in pharmacological, non-pharmacological, and neurostimulation treatments may provide more chance for successful treatment of CM.

http://ift.tt/2o62odt

Sporadic Insulinoma as a Rare Cause of Recurrent Hypoglycemia in Children

Insulinoma is a rare pancreatic tumor in children and adolescents. As a result of insulin hypersecretion, signs and symptoms are more commonly consequences of the pathophysiologic responses to hypoglycemia. According to rarity of this tumor in children and nonspecificity of clinical presentations, diagnosis of insulinoma in this group of patients is usually delayed. Early diagnosis is very important for preventing neurologic damage. In this case report, we present the case of a 10-year-old boy with signs and symptoms of hypoglycemia and final diagnosis of insulinoma.

http://ift.tt/2oXhr8o

Acoustic Analysis of Indian Teachers’ Voice: Pre and Post Teaching Circumstances

Abstract

Compared to people employed in other occupations, teachers are more likely to report having voice problems. They are more likely to perceive that their voice problems limit their current job performance and also adversely affect their future career options. The current study examines the acoustic parameters that are sensitive to vocal loading in pre and post teaching circumstances and adds to the existing literature. Voice samples were recorded from 30 primary school teachers, 15 females and 15 males in the age range of 28–35 years (mean age 29.3 years), with teaching experience of 10–12 years. Mean pitch, minimum pitch, maximum pitch, number of voice breaks, jitter local, shimmer local and mean harmonic to noise ratio were estimated using PRAAT software before and after a typical teaching day. Significant difference was seen when number of voice breaks was compared in pre and post teaching conditions in both males (p = 0.02) and females (p = 0.02) in the conversation task. Moreover, significant differences in mean pitch was observed in the task of slogan repetition (p = 0.03), but only in males. These parameter can be used as indicators of vocal fatigue among teachers and can be used in objective determination of at risk population.

http://ift.tt/2oMEkLu

News in Thyroid Research and Care: A Q&A with the American Thyroid Association

A leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders, the American Thyroid Association president-elect, Dr. Charles Emerson, spoke with WomensHealth.com. Read the Interview

The post News in Thyroid Research and Care: A Q&A with the American Thyroid Association appeared first on American Thyroid Association.

http://ift.tt/2o5lkZP

Correction: Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study

by Sae-Hoon Kim, Ha-Kyeong Won, Sung-Do Moon, Byung-Keun Kim, Yoon-Seok Chang, Ki-Woong Kim, In-Young Yoon

http://ift.tt/2pCS9KO

Increasing the accuracy of mandibular reconstruction with free fibula flaps using functionalized selective laser-melted patient-specific implants A retrospective multicenter analysis

In this study, selective laser melted patient specific functional implants (PSFI) were utilised in combination with a fibula free flap, for mandible reconstruction. The shape and length of the PSFI, the shaping of fibula graft, its angulation and the length of the screws, were virtually planned before the surgery. Information, such as resection margin and screw lengths, were coded on the implant.22 patients were reconstructed with PSFI and fibula transplantation. Data collected related to the size of the defect, pre- and postoperative intercondylar distance, ischemia time, time consumed to shape the fibula graft and complications.

http://ift.tt/2pEeoQt

Three-dimensional surgical modelling with an open-source software protocol: study of precision and reproducibility in mandibular reconstruction with the fibula free flap

Very few surgical teams currently use totally independent and free solutions to perform three-dimensional (3D) surgical modelling for osseous free flaps in reconstructive surgery. This study assessed the precision and technical reproducibility of a 3D surgical modelling protocol using free open-source software in mandibular reconstruction with fibula free flaps and surgical guides. Precision was assessed through comparisons of the 3D surgical guide to the sterilized 3D-printed guide, determining accuracy to the millimetre level.

http://ift.tt/2o5LQT5

Comparison between piezoelectric surgery and conventional saw in sagittal split osteotomies: a systematic review

A systematic review of the advantages and disadvantages of piezoelectric surgery in comparison with conventional saws for sagittal split osteotomy (SSO) was performed. Relevant studies published in the last 10 years were identified through a search of the PubMed/MEDLINE, Science Direct, and Embase databases and assessed against predetermined eligibility criteria. The initial search resulted in 1736 articles. After applying the inclusion and exclusion criteria, 12 articles remained. A total of 799 patients with an average age of 27.5 years underwent SSO performed using a saw or ultrasonic device.

http://ift.tt/2oR3o2p

Correction: Impact of self-reported symptoms of allergic rhinitis and asthma on sleep disordered breathing and sleep disturbances in the elderly with polysomnography study

by Sae-Hoon Kim, Ha-Kyeong Won, Sung-Do Moon, Byung-Keun Kim, Yoon-Seok Chang, Ki-Woong Kim, In-Young Yoon

http://ift.tt/2pCS9KO

Perioperative risks of narcolepsy in patients undergoing general anesthesia: A case-control study

To compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management.

http://ift.tt/2pDW8cQ

Hearing and Mortality Outcomes following Temporal Bone Fractures

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1601885

The aim of this article is to determine hearing and mortality outcomes following temporal bone fractures. Retrospective chart review was performed of 152 patients diagnosed with a temporal bone fracture presenting to the emergency room at a tertiary care referral center over a 10-year period. Utilizing Patients' previously obtained temporal bone computed tomographic scans and audiograms, fractures were classified based on several classification schemes. Correlations between fracture patterns, mortality, and hearing outcomes were analyzed using χ 2 tests. Ossicular chain disruption was seen in 11.8% of patients, and otic capsule violation was seen in 5.9%; 22.7% of patients presented for audiologic follow-up. Seventeen patients with conductive hearing loss had air–bone gaps of 26 ± 7.5 dB (500 Hz), 27 ± 6.8 dB (1,000 Hz), 18 ± 6.2 dB (2,000 Hz), and 32 ± 7.7 dB (4,000 Hz). Two cases of profound sensorineural hearing loss were associated with otic capsule violation. No fracture classification scheme was predictive of hearing loss, although longitudinal fractures were statistically associated with ossicular chain disruption (p < 0.01). Temporal bone fractures in patients older than 60 years carried a relative risk of death of 3.15 compared with those younger than 60 years. The average magnitude of conductive hearing loss resulting from temporal bone fracture ranged from 18 to 32 dB in this cohort. Classification of fracture type was not predictive of hearing loss, despite the statistical association between ossicular chain disruption and longitudinal fractures. This finding may be due to the low follow-up rates of this patient population. Physicians should make a concerted effort to ensure that audiological monitoring is executed to prevent and manage long-term hearing impairment.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1601865

Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2pE11zZ

Proptosis and vision loss as grave complications of allergic fungal sinusitis and polyposis

Allergic fungal sinusitis and polyposis are noninvasive, but aggressive, inflammatory responses to mold that occur in immunocompetent patients with chronic sinusitis and nasal polyposis.1 An association of these conditions with vitamin D deficiency has been reported.2 In severe cases, patients with allergic fungal sinusitis present with ophthalmic signs and symptoms, such as proptosis, diplopia, and, in extreme cases, vision loss.3 Most cases require surgical intervention, corticosteroids, and ongoing surveillance.

http://ift.tt/2oQTGNu

Skeletal myositis as the sole feature of relapsing drug reaction with eosinophilia and systemic symptoms syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome represents a potentially life-threatening systemic immune response to medication. It is characterized by rash, fever, lymphadenopathy, eosinophilia, and internal organ involvement, most commonly hepatitis. We report a case of DRESS syndrome caused by sulfasalazine with acute morbilliform rash, fever, eosinophilia, and hepatitis with subsequent skeletal muscle involvement. To date, literature reports of skeletal muscle involvement with DRESS syndrome have been limited to 2 cases, only one of which involved histopathologic evidence of eosinophilic infiltration on skeletal muscle biopsy.

http://ift.tt/2phjsgK

Asthma and risk of coronary heart disease

Few studies have investigated the incidence of coronary heart disease (CHD) in patients with asthma, and their results remain inconclusive.

http://ift.tt/2oQHY5i

Assessment of condyle position, fossa morphology and disc displacement in symptomatic patients

Publication date: Available online 19 April 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Katharina Alves Rabelo, Saulo Leonardo Sousa Melo, Marianna Guanaes Gomes Torres, Larissa Rangel Peixoto, Paulo Sérgio Flores Campos, Iêda Margarida Crusoé Rocha Rebello, Daniela Pita de Melo
ObjectiveTo determine whether associations exist between the morphology of the glenoid fossa, articular spaces and disc displacement by evaluating magnetic resonance imaging (MRI) of symptomatic patients. Sex and age were also evaluated for any effect on the parameters.Study DesignMRI scans of 199 temporomandibular joints were assessed for the morphology of the glenoid fossa and articular spaces in both sagittal and coronal views. The presence of disc displacement and its type in closed- and open-mouth positions were also assessed. ANOVA, Tukey and Student t-tests or Mann-Whitney rank sum tests were used to investigate associations between these variables.ResultsA total of 113 joints (56.8%) presented with disc displacement. The articular spaces in the sagittal and coronal views were overall significantly larger in males than females in three of the six spaces (superior, posterior, and central spaces). Larger superior and medial articular spaces were associated with angled glenoid fossae. Higher mean values of the articular space sizes were associated with normal disc position (p<0.001), except for the anterior articular space. When displacement was identified, higher values of the articular space sizes were also associated with disc reduction in open-mouth position (p<0.05).ConclusionCondyles in a central position in the coronal view and slightly anteriorly positioned in the sagittal view are less likely to present disc displacement.



http://ift.tt/2oonXCa

Blood Pressure and Blood Sugar Assessment by Recent Dental School Graduates

Publication date: Available online 19 April 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michael N. Hatton, Heather Orom, Patrick L. Anders
ObjectiveTo determine whether 2010-2014 graduates of the School of Dental Medicine at Buffalo, NY (UB-SDM) continue to assess blood pressure and capillary blood sugar after graduation.MethodsStarting in 2010, UB-SDM pre doctoral students were required to assess blood pressure (BP) on all patients, and capillary blood sugar (CBS) on all diabetic patients at every clinic appointment. UB-SDM graduates from 2010-2014 were sent an anonymous survey consisting of 34 questions to determine whether these assessments continue after graduation. The survey consisted of BP/CBS assessment parameters, including benefits and barriers to assessments.ResultsWhile UB-SDM graduates generally assessed BP (77%) and CBS (23%), most did not follow the school's strict educational policies when providing these services. Dental practice policies mandating BP/CBS assessments were positively correlated with UB-SDM graduate's actually providing these services. Lack of time and poor practice support were cited as negative factors towards BP/CBS assessments.ConclusionsDisparities between UB-SDM educational efforts and entrenched dental practice cultures must be addressed in order for our graduates to fully embrace BP/CBS assessments in practice.

Teaser

Recent dental school graduates' willingness to assess blood pressure/blood sugar in practice is positively influenced by having a work place policy fostering these assessments. Negative influences towards these assessments include practice culture issues, and time management concerns.


http://ift.tt/2pDRtaU

Cystic lesions of the jaws: a retrospective clinicopathological study of 2030 cases

Publication date: Available online 19 April 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Lorenzo Lo Muzio, Marco Mascitti, Andrea Santarelli, Corrado Rubini, Fabrizio Bambini, Maurizio Procaccini, Dario Bertossi, Massimo Albanese, Vincenzo Bondì, Pier Francesco Nocini
ObjectiveThe aim of this study was to perform an epidemiological analysis of jawbone cysts at Dentistry and Maxillofacial surgery Unit at the Verona Hospital, Italy, from 1973 to 2012, and to compare the data obtained with those published in literature.Study DesignA retrospective survey of 2030 patients treated for jawbone cysts from 1973 to 2012 was performed. The lesions were classified according to 2005 WHO histological classification, and the following variables were analyzed: age, gender, histopathological diagnosis, and onset site.ResultsIn a total of 2030 lesions, there were 1970 odontogenic cysts (97.04%), 50 non-odontogenic cysts (2.46%), and 10 pseudocysts (0.49%). 314 patients were children (15.47%), whereas 1716 were adults (84.53%). Mean age was 37.24 years, with a M:F ratio of 1.71:1.ConclusionsThere is a wide variety of cysts, some of which are subject to variations according to sex, localization, and age.



http://ift.tt/2oopQij

Transoral and transcutaneous approach for removal of parotid gland calculus: A 10-year endoscopic experience

Publication date: Available online 19 April 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Xin Ye, Ya-Qiong Zhang, Xiao-Yan Xie, Deng-Gao Liu, Lei Zhang, Guang-Yan Yu
ObjectiveTo evaluate safety, effectiveness, and long-term gland function of endoscopy-assisted lithectomy for parotid gland calculusStudy designOverall, 116 consecutive patients with parotid gland calculus underwent endoscopy-assisted lithectomy at our center. The immediate safety and effectiveness were evaluated. After surgery, the patients were followed up, and gland function was analyzed by clinical manifestations and sialography.ResultsComplete stone extraction was achieved in 110 cases (94.8%, 110/116) by using a transoral (95 cases) or transcutaneous (15 cases) approach. At a median follow-up of 3 years, clinical outcomes were excellent in 86 cases (78.2%), fair in 16 cases (14.5%), and poor in 5 cases (4.5%). Postoperative sialographic appearance in 30 stone-free patients was categorized into 3 types: (1) normal (13 cases); (2) the main duct had ectasia or stenosis, but no persistent contrast was seen on functional films (10 cases); and (3) the main duct had ectasia or stenosis, and persistent contrast was evident on functional films (7 cases).ConclusionsIn the absence of lithotripsy, appropriate application of various minimally invasive endoscopic procedures confirms safety and effectiveness of stone extraction for parotid calculi. Sialography is a viable method for evaluation of postoperative gland function.



http://ift.tt/2pDFPNm

A new method of volumetric assessment of alveolar bone grafting for cleft patients using CBCT

Publication date: Available online 19 April 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Bin Feng, Meng Jiang, Xue Xu, Jingtao Li
ObjectivesThe aims of this study were to propose a new method for volumetric assessment of alveolar bone grafting, and to quantitatively assess the alveolar bone grafting based on this method.Study DesignCBCT images of 18 patients with unilateral cleft alveolus were selected. Volume of alveolar cleft before grafting operation (VOLcleft), graft bone filled into cleft immediately after operation (VOLgraft), and bony bridge formed 1 year after operation (VOLbridge) were obtained. Grafting filling rate (VOLgraft/VOLcleft×100%), bony bridge forming rate (VOLbridge/VOLcleft×100%), and grafting resorption rate [(VOLgraft-VOLbridge)/VOLgraft×100%] were calculated. Correlations between these parameters were investigated. Intra- and inter-observer reliability of this method was assessed.ResultsIntra- and inter-observer reliability was good as no statistically significant difference was seen, and Pearson correlation coefficient was profound (intra-observer: r≥0.953, inter-observer: r≥0.859). A positive linear correlation (R2=0.808, P＜0.001) between grafting filling rate and bony bridge forming rate, and a negative linear correlation (R2=0.458, p=0.002) between grafting filling rate and grafting resorption rate were found.ConclusionThis method was practical and valuable for quantitatively assessment of alveolar bone grafting.



http://ift.tt/2ooswMH

Histopathological findings of extra-ileal manifestations at initial diagnosis of Crohn’s disease-related ileitis

http://ift.tt/2phvvdU

The risk of bias in randomized controlled trials in otorhinolaryngology: hardly any improvement since 1950

Randomized Controlled Trials (RCTs) represent the most valuable study design to evaluate the effectiveness of therapeutic interventions. However, flaws in design, conduct, analysis, and reporting of RCTs can c...

http://ift.tt/2oQHxYC

The effects of intermittent low-dose PTH treatment on rapid mandibular osteodistraction in rabbits

Publication date: Available online 19 April 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Bin Ye, Yunfeng Li, Songsong Zhu, Shengjun Sun, Jing Hu, Shujuan Zou
PurposeTo determine whether low-dose recombinant human parathyroid hormone (rhPTH) would have a beneficial effect on regenerate healing and surrounding bone in a rabbit rapid mandibular osteodistraction model.Materials and MethodsTwenty-eight rabbits underwent unilateral mandiblular lengthening at a rapid rate of 2mm/day for 5 days. From the first day of distraction, the experimental group received daily subcutaneous injections of 10μg/kg of rhPTH for 30 days and the control group received the same volume of saline( n=14 in each group). At 6 weeks after completion of distraction, the distracted callus was examined by micro-computed tomography (micro-CT), histology and three-point bending test. Moreover, the bone mineral density of anterior pin region was evaluated by dual energy X-ray absorptiometry (DXA).ResultsUnder a rapid distraction, poor bone healing was observed in the distracted callus from control group. However, more mature and abundant bone formation was found in the distracted callus from experimental group by histological and micro-CT examinations. Quantitatively, the PTH-treated animals had the greater parameters in bone volume fraction, trabecular number and trabecular thickness as well as mechanical properties when compared with controls (p < 0.05). Bone mineral density of anterior pin region was higher in the experimental than that in the control group (p < 0.05).ConclusionNot only can low-dose intermittent rhPTH administration enhance new bone formation but also it can prevent fixitor-related osteoporosis of surrounding segments following rapid mandibular osteodistraction in rabbits.



http://ift.tt/2pE4ui3

Acoustic Analysis of Indian Teachers’ Voice: Pre and Post Teaching Circumstances

Abstract

Compared to people employed in other occupations, teachers are more likely to report having voice problems. They are more likely to perceive that their voice problems limit their current job performance and also adversely affect their future career options. The current study examines the acoustic parameters that are sensitive to vocal loading in pre and post teaching circumstances and adds to the existing literature. Voice samples were recorded from 30 primary school teachers, 15 females and 15 males in the age range of 28–35 years (mean age 29.3 years), with teaching experience of 10–12 years. Mean pitch, minimum pitch, maximum pitch, number of voice breaks, jitter local, shimmer local and mean harmonic to noise ratio were estimated using PRAAT software before and after a typical teaching day. Significant difference was seen when number of voice breaks was compared in pre and post teaching conditions in both males (p = 0.02) and females (p = 0.02) in the conversation task. Moreover, significant differences in mean pitch was observed in the task of slogan repetition (p = 0.03), but only in males. These parameter can be used as indicators of vocal fatigue among teachers and can be used in objective determination of at risk population.

http://ift.tt/2oMEkLu

Targeting High Calcineurin Inhibitor Levels after Acute Rejection with Less Tremor: A New Strategy.

No abstract available

http://ift.tt/2o4YaCS

Insights into the diversity of NOD-like receptors: Identification and expression analysis of NLRC3, NLRC5 and NLRX1 in rainbow trout

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Claudio A. Álvarez, Felipe Ramírez-Cepeda, Paula Santana, Elisa Torres, Jimena Cortés, Fanny Guzmán, Paulina Schmitt, Luis Mercado
Nucleotide-binding oligomerization domain (NOD)-like receptors (NLRs) are efficient soluble intracellular sensors that activate defense mechanisms against pathogens. In teleost fish, the involvement of NLRs in the immune response is not well understood. However, recent work has evidenced the expression of different NLRs in response to some pathogen associated molecular patterns (PAMPs). In the present work, the cDNA sequence encoding three new NOD-like receptors were identified in Oncorhynchus mykiss, namely OmNLRC3, OmNLRC5 and OmNLRX1. Results showed that their sequences coded for proteins of 1135, 836 and 1010 amino acids, respectively. The deduced protein sequences of all receptors showed characteristic domains of this receptor family, such as leucine rich repeats and NACHT domain. Phylogenetic analysis revealed a high degree of identity with other NOD-like receptors and they are clustered into different families. Transcript expression analysis indicated that OmNLRs are constitutively expressed in liver, spleen, intestine, gill, skin and brain. OmNLR expression was upregulated in kidney and gills from rainbow trout in response to LPS. In order to give new insights into the function of these new NLR members, an in vitro model of immune stimulation was established using the rainbow trout cell line RTgill-W1. Expression analysis revealed that RTgill-W1 overexpressed proinflammatory cytokines in response to LPS and poly I:C alongside with a differential overexpression of OmNLRC3, OmNLRC5 and OmNLRX1. The expression of OmNLRC5 was further verified at the protein level by immunofluorescence. Finally, the effect of the overexpressed cytokines on the OmNLR expression by RTgill-W1 cells was assessed, suggesting a regulatory mechanism on OmNLRC3 expression. Overall, results suggest that O. mykiss NOD-like receptors could play a key role in the defense mechanisms of teleost through PAMP recognition. Future studies will focus on gills which could be related with a key sensor mucosal system in one of the most environmentally fish exposed tissues.



http://ift.tt/2oQoMEV

Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II

The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery.

http://ift.tt/2oMzAFH

Nitrous oxide for labor analgesia: Utilization and predictors of conversion to neuraxial analgesia

We examined the characteristics of women who choose nitrous oxide for labor analgesia and identified factors that predict conversion from nitrous oxide to labor neuraxial analgesia.

http://ift.tt/2osZTx6

The analysis of expression of p16 protein in group of 53 patients treated for sinonasal inverted papilloma

Publication date: Available online 19 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Roland Zydroń, Andrzej Marszałek, Magdalena Bodnar, Paweł Kosikowski, Grażyna Greczka, Małgorzata Wierzbicka
IntroductionSinonasal Inverted Papilloma (IP) constitute relevant therapeutic problem due to destructive character of growth, tendency to recur and the possibility of malignant transformation. Therefore, many attempts to identify risk factors for IP occurrence have been undertaken, as well as research to find markers that would allow for the earlier detection of tumors and the application of adequate therapy. A widely known risk factor of IP is HPV infection. One of the markers of HPV infection and the ongoing effect of this change (although arousing some controversy) is the expression of the p16 protein.ObjectiveThe aim of the study was to analyze the correlation between the expression of p16 as a surrogate of HPV infection in analyzed histopathological material and epidemiological variables, recurrences or malignant transformation.MethodsThe retrospective study includes a group of 53 patients (18 women and 35 men) undergoing treatment for sinonasal IP in the period of 2002–2012. The intensity of the p16 protein in histopathological material was scored as: 0 – no expression, 1 – diffuse expression (borderline) and 2 – positive expression; or 0 – no expression/diffuse expression (borderline); 1 – positive expression. The Ethics Committee agreement was obtained (1089/12; 245/13).Results and conclusionThere was no statistically significant relationship between the expression of p16 and the age of patients, cigarette smoking, tumor location, tumor staging according to the Krouse and Cannady classification, the presence of dysplasia or the occurrence of relapse.



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Higher plasma leptin is associated with higher risk of androgenetic alopecia in men

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CD80CD86 deficiency disrupts regulatory CD4+FoxP3+T cell homeostasis and induces autoimmune-like alopecia

Abstract

Alopecia areata (AA) is an autoimmune disease that results in spot baldness in humans. Adequate animal models for AA are currently lacking. The objective of this study was to elucidate the mechanism of autoimmune-like alopecia (ALA) in C57BL/6.CD80CD86-deficient (B6.CD80CD86^-/-) mice.

Incidence and severity of alopecia were analyzed in 58 B6.CD80CD86^-/- mice by using histological examination, flow cytometry, multiplex enzyme-linked immunosorbent assay, quantitative RT-PCR, and CD25 inhibition test. Both male and female B6.CD80CD86^-/- mice showed almost 100% incidence of hair loss at 40 weeks of age. Moreover, CD4+FoxP3+Treg (Treg) cell population in B6.CD80CD86^-/- mice was significantly lower than in B6 mice, which presumably underlined autoimmune reaction. Histologically, B6.CD80CD86^-/- mice showed CD4+ and CD8+ T-cell infiltration around terminal follicle region and exhibited hair follicle destruction in the anagen or catagen stage. Negative correlation between the number of CD4+FoxP3+ Tregs and ALA was confirmed by the CD25 depletion test in B6 mice, as follicle destruction was similar to that observed in B6.CD80CD86^-/- animals.

CD80CD86 deficiency disrupted CD4+FoxP3+ Treg homeostasis and prompted the development of ALA. We demonstrated that B6.CD80CD86^-/- mice might have several advantages as an ALA model, because they exhibited high incidence of disease phenotype and epipathogenesis similar to that observed in human AA.

This article is protected by copyright. All rights reserved.

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Combined activity of temozolomide and the mTOR inhibitor temsirolimus in metastatic melanoma involves DKK1

Abstract

The BRAFV600E inhibitor vemurafenib achieves remarkable clinical responses in patients with BRAF-mutant melanoma, but its effects are limited by the onset of drug resistance. In the case of resistance, chemotherapy can still be applied as second line therapy. However, it yields low response rates and strategies are urgently needed to potentiate its effects. In a previous study, we showed that the inhibition of the PI3K-AKT-mTOR pathway significantly increases sensitivity of melanoma cells to chemotherapeutic drugs (1).

In the current study the combination of the mTOR inhibitor temsirolimus with the chemotherapeutic agent temozolomide significantly increases growth inhibition and apoptosis in melanoma cells compared to temsirolimus or temozolomide alone. The combination of temozolomide with temsirolimus is not only effective in established but also in newly isolated and vemurafenib-resistant metastatic melanoma cell lines. These effects are associated with the down-regulation of the antiapoptotic protein Mcl-1 and the up-regulation of the Wnt antagonist Dickkopf homolog 1 (DKK1). Knockdown of DKK1 suppresses apoptosis induction by the combination of temsirolimus and temozolomide.

These data suggest that the inhibition of the mTOR pathway increases sensitivity of melanoma cells towards temozolomide. Chemosensitization is associated with enhanced expression of the Wnt antagonist DKK1.

This article is protected by copyright. All rights reserved.

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A novel JAK inhibitor JTE-052 reduces skin inflammation and ameliorates chronic dermatitis in rodent models: comparison with conventional therapeutic agents

Abstract

Janus kinases (JAKs) are required for several inflammatory cytokine signaling pathways and are implicated in the pathogenesis of chronic dermatitis, including atopic dermatitis and psoriasis. JAK inhibitors are therefore promising therapeutic candidates for chronic dermatitis. In this study, we evaluated the effects of the novel JAK inhibitor JTE-052 on inflammatory responses associated with chronic dermatitis, and compared its profile with those of conventional therapeutic agents in rodent models of chronic dermatitis. JTE-052 inhibited the Th1-, Th2-, and Th17-type inflammatory responses of human T cells and mast cells in vitro. Oral administration of JTE-052 inhibited skin inflammation in hapten-induced chronic dermatitis in mice, associated with reduced levels of inflammatory cytokines in the skin and immunoglobulin (Ig) E in serum. In contrast, although ciclosporin partly inhibited skin inflammation, it did not reduce interleukin (IL)-4 production in skin, and enhanced IgE production in serum. Oral administration of JTE-052 also inhibited skin inflammation in mouse models of atopic dermatitis and psoriasis induced by a mite extract, thymic stromal lymphopoietin, or IL-23. The maximal efficacy of JTE-052 in these dermatitis models was superior to the conventional therapeutic agents, ciclosporin and methotrexate. Topical application of JTE-052 ointment ameliorated hapten-induced chronic dermatitis in rats more effectively than tacrolimus ointment. Furthermore, JTE-052 ointment did not cause the thinning of normal skin associated with topical corticosteroids. These results indicate that JTE-052 is a promising candidate as an anti-inflammatory drug for various types of chronic dermatitis, with a distinctly different profile from conventional therapy following either oral or topical application.

This article is protected by copyright. All rights reserved.

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Morphology of the inferior border of the mandible: correct relation between the lowest position of the outer and inner contours of the cortex for a successful split

Publication date: Available online 18 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Matsushita, M. Donen, S. Harata, K. Nagamine, K. Tei
For a sagittal split ramus osteotomy to be secure, the relation between the outer and inner contours of the cortex at the inferior border of the mandible is critical. The lowest point of the outer contour is not always immediately below that of the inner contour, and the former is placed more lingually than the latter in about a third of all cases. This tendency is much more noticeable in skeletal class I and II malocclusions than class III. It is therefore important to examine the lowest point of the inferior border in every case, and to carry the inferior part of the buccal cut on to the lingual side if necessary.



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Swen Malte John zum 60. Geburtstag

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Thoracic Surgery Combined With Intrathoracic Hyperthermic Perfusion for Advanced Lung Cancer / Esophageal Cancer

Conditions:   Esophageal Cancer;   Lung Cancer;   Hyperthermic Perfusion
Intervention:   Other: hyperthermic perfusion
Sponsor:   Henan Cancer Hospital
Recruiting - verified April 2017

http://ift.tt/2pCeTxf

Leonine Facies, Flushing, and Systemic Symptoms

A man in his 50s with history of hypertension and pulmonary tumor resected 10 years earlier presented with generalized phymatous changes over his entire face as well as pustular lesions and a diffuse erythema that gave him an appearance of leonine facies. What is your diagnosis?

http://ift.tt/2oOJGV1

Typographical Errors and Missing Table Footnote

In the article titled "Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines: Results of a National Institutes of Health Working Group," there were typographical errors in both the Figure and the Table, and there was a missing footnote in the Table. This article has been corrected online.

http://ift.tt/2o3QSiD

Internal Store-and-Forward System in an Existing Electronic Health Record

This pilot study describes a store-and-forward teledermatology workflow within an existing electronic health record system, assesses its effectiveness in improving access to care, validates its reliability, and evaluates its ability to capture meaningful outcomes.

http://ift.tt/2oOTeiJ

Multiple Facial Trichoepitheliomas and Vulval Cysts

This case study describes a unique incidence of multiple trichoepitheliomas in combination with epidermoid cysts of the vulva in association with a novel pathogenic mutation in CYLD, extending the phenotypic spectrum.

http://ift.tt/2o3S3ik

An Unusual Case of SCACPIS With Macular Amyloidosis

This case report describes an unusual case of syringocystadenocarcinoma papilliferum in situ with macular amyloidosis.

http://ift.tt/2oOHDQH

Declining Melanoma Rates in New England States

To the Editor The research letter "Comparison of Regional and State Differences in Melanoma Rates in the United States: 2003 vs 2013" was insightful and valuable. In speculating about the decline in New England melanoma incidence and death rates during the 10-year period, the authors attributed the results to skin cancer prevention programs and specifically cited the influence of the Melanoma Foundation of New England (MFNE).

http://ift.tt/2o49UWb

Efficacy and Safety of Propranolol vs Steroid for Infantile Hemangioma

This randomized clinical trial compares propranolol vs steroid therapies for efficacy and safety in the treatment of infantile hemangioma.

http://ift.tt/2oOXFtJ

Diversity in Dermatology

This Viewpoint focuses on underrepresented minorities in the field of dermatology and presents 5 actions endorsed by the Association of Professors of Dermatology to grow a more diverse dermatology workforce.

http://ift.tt/2o3OMPT

Cross-sectional human study of soft tissue chin (STC) thickness in adult patients in relation to sex, facial pattern and skeletal class

Publication date: Available online 19 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yolanda Gomez, Natalia Zamora, Beatriz Tarazona, Carlos Bellot, V. Paredes
PurposeThe aim of this study was to study the relations between the soft tissue chin (STC) and sex, skeletal class, and facial pattern; and to describe the shape and behavior of the STC.Methods385 non-growing patients were selected, 206 women and 179 men, with a mean age of 28.8 years (SD 4.2). Patients were divided into groups by skeletal class (class I, II or III) and facial pattern (brachyfacial, mesofacial or dolichofacial). STC thicknesses were measured at pogonion (Pg), soft pogonion (Pg´), gnathion (Gn), soft gnathion (Gn´), menton (Me) and soft menton (Me´) in the CBCTs.ResultsSexual dimorphism was observed at Pg-Pg´ and Me-Me´. STC thickness was not related to skeletal class but related to facial pattern. Pg-Pg´ and Me-Me´ measurements showed significant differences to the combination of skeletal class/facial pattern. STC thickness was not homogenous in terms of shape and behavior.ConclusionsThe results provide evidence of a strong but complex relationship between sex, facial pattern, skeletal class and STC thickness; for this reason, each patient must be evaluated individually before undergoing orthodontics or orthognatic surgery involving the mandible and the mandibular symphysis.



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Cytoprotective effects of melatonin on zoledronic acid-treated human osteoblasts

Publication date: Available online 18 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): F. Camacho-Alonso, I. Urrutia-Rodríguez, D. Oñate-Cabrerizo, R.E. Oñate-Sánchez, F.J. Rodríguez-Lozano
ObjectiveTo evaluate the cytoprotective effects of melatonin (MLT) on zoledronic acid (ZA)-treated human osteoblasts.MethodsHuman osteoblasts were exposed to ZA (1, 5, 10, 50, 100 and 300 μM) and MLT (1, 10, 50, 100 y 200 μM) for 24, 48 and 72 hours of incubation, to evaluate their effects on cell viability.ResultsAs ZA concentration increased, greater reductions in cell viability of human osteoblasts were induced whether at 24, 48 or 72 hours incubation. At 24 hours incubation with MLT, greatest cell viability was obtained when low dose of MLT was applied (without significant differences); 48 and 72 hours incubation presented the greatest cell viability with the highest MLT concentrations (100 and 200 μM). MLT at concentrations of 100 and 200 μM would appear to have a certain cytoprotective effect on ZA-treated human osteoblasts with low concentrations of ZA (1 y 5 μM), whether at 24, 48 or 72 hours; however, at ZA concentrations ≥10 μM the possible cytoprotective effects of MLT were low at 24 hours incubation.ConclusionsMLT has a cytoprotective effect on ZA-treated human osteoblasts and could represent a promising preventative alternative for patients at risk of bisphosphonate-related osteonecrosis of the jaw.



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Comparison of two- and three-dimensional assessment methods of nasolabial appearance in cleft lip and palate patients

Publication date: Available online 19 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): David G.M. Mosmuller, Thomas.J. Maal, Charlotte Prahl, Robin. A. Tan, Frans J. Mulder, Roderic M.F. Schwirtz, Henrica C.W. de Vet, Stefaan J. Bergé, J.P.W. Don Griot
ObjectiveFor the assessment of the nasolabial appearance in cleft patients, a widely accepted, reliable scoring system is not available. In this study four different methods of assessment are compared, including 2D and 3D asymmetry and aesthetic assessments.MethodsThe data and ratings from an earlier study using the Asher-McDade aesthetic index on 3D photographs and the outcomes of 3D facial distance mapping were compared to a 2D aesthetic assessment, the Cleft Aesthetic Rating Scale, and to Symnose, a computerized 2D asymmetry assessment technique. The reliability and correlation between the four assessment techniques were tested using a sample of 79 patients.ResultsThe 3D asymmetry assessment had the highest reliability and could be performed by just one observer (Intraclass correlation coefficient (ICC): 0.99). The 2D asymmetry assessment of the nose was highly reliable when performed by just one observer (ICC: 0.89). However, for the 2D asymmetry assessment of the lip more observers were needed. For the 2D aesthetic assessments 3 observers were needed. The 3D aesthetic assessment had the lowest single-observer reliability (ICC: 0.38–0.56) of all four techniques.The agreement between the different assessment methods is poor to very poor. The highest correlation (R: 0.48) was found between 2D and 3D aesthetic assessments. Remarkably, the lowest correlations were found between 2D and 3D asymmetry assessments (0.08–0.17).ConclusionDifferent assessment methods are not in agreement and seem to measure different nasolabial aspects. More research is needed to establish exactly what each assessment technique measures and which measurements or outcomes are relevant for the patients.



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International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus

Publication date: Available online 18 April 2017
Source:Autoimmunity Reviews
Author(s): Jean-François Kleinmann, Florence Tubach, Véronique Le Guern, Alexis Mathian, Christophe Richez, David Saadoun, Karim Sacre, Jérémie Sellam, Raphaèle Seror, Zahir Amoura, Emmanuel Andres, Sylvain Audia, Brigitte Bader-Meunier, Gilles Blaison, Bernard Bonnotte, Patrice Cacoub, Sophie Caillard, Laurent Chiche, Olivier Chosidow, Nathalie Costedoat-Chalumeau, Claire Daien, Eric Daugas, Nairouz Derdèche, Andrea Doria, Olivier Fain, Fadi Fakhouri, Dominique Farge, Cem Gabay, Sylvie Guillo, Eric Hachulla, Najia Hajjaj-Hassouni, Mohamed Hamidou, Frédéric A. Houssiau, Noémie Jourde-Chiche, Isabelle Koné-Paut, Aïcha Ladjouz-Rezig, Olivier Lambotte, Dan Lipsker, Xavier Mariette, Nicolas Martin-Silva, Thierry Martin, François Maurier, Roderich Meckenstock, Arsène Mékinian, Olivier Meyer, Shirine Mohamed, Jacques Morel, Bruno Moulin, Denis Mulleman, Thomas Papo, Vincent Poindron, Xavier Puéchal, Leonardo Punzi, Pierre Quartier, Laurent Sailler, Amar Smail, Martin Soubrier, Agnès Sparsa, Zoubida Tazi-Mezalek, Leith Zakraoui, Stéphane Zuily, Jean Sibilia, Jacques-Eric Gottenberg
Background/PurposeDespite conventional immunosuppressants, active and steroid-dependent systemic lupus erythematosus (SLE) represents a therapeutic challenge. Only one biologic, belimumab, has been approved, but other biologics are sometimes used off-label. Given the lack of evidence-based data in some clinical situations encountered in real life, we developed expert recommendations for the use of biologics for SLE.MethodsThe recommendations were developed by a formal consensus method. This method aims to formalise the degree of agreement among experts by identifying, through iterative ratings with feedback, the points on which experts agree, disagree or are undecided. Hence, the recommendations are based on the agreed-upon points. We gathered the opinion of 59 French-speaking SLE experts from 3 clinical networks dedicated to systemic autoimmune diseases (FLEUR, IMIDIATE, FAI2R) from Algeria, Belgium, France, Italy, Morocco, Switzerland and Tunisia. Represented medical specialities were internal medicine (49%), rheumatology (34%), nephrology (7%), dermatology (5%), pediatrics (3%) and cardiology (2%). Two methodologists and 3 strictly independent SLE expert groups contributed to developing these recommendations: a steering group (SG) (n=9), an evaluation group (EG) (n=28) and a reading group (RG) (n=22). Preliminary recommendations were drafted by the SG, then proposed to the EG. Each EG member rated the degree of agreement from 1 to 9 (1: lowest; 9: strongest) for each recommendation. After 2 rating rounds, the SG submitted a new version of the recommendations to the RG. With comments from the RG, the SG finalised the recommendations.ResultsA total of 17 final recommendations were formulated by the SG, considering all agreement scores and comments by the EG and RG members and the two methodologists. These recommendations define the subset of patients who require a biologic; the type of biologics to use (belimumab, rituximab, etc.) depending on the organ involvement and associated co-treatments; what information should be given to patients; and how to evaluate treatment efficacy and when to consider discontinuation.ConclusionOverall, 17 recommendations for the good use of biologics in SLE were formulated by a large panel of SLE experts to provide guidance for clinicians in daily practice. These recommendations will be regularly updated according to the results of new randomized trials and increasing real life experience.



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Comparison of the mechanical properties of different skin sites for auricular and nasal reconstruction

Autologous and synthetic nasal and auricular frameworks require skin coverage. The surgeon's decides on the appropriate skin coverage for reconstruction based on colour matching, subcutaneous tissue thickness,...

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Erratum to: Successful Management of Zoon’s Balanitis with Topical Mupirocin Ointment: A Case Report and Literature Review of Mupirocin-Responsive Balanitis Circumscripta Plasmacellularis

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Absence of myoepithelial cells correlates with invasion and metastasis of Carcinoma ex pleomorphic adenoma

Publication date: Available online 18 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Ye, Y. Gao, T. Wei, G.-Y. Yu, X. Peng
Myoepithelial cells (MECs) are implicated in the development and progression of human salivary gland tumours. Here, we investigate the potential role for MECs in invasion and metastasis of carcinoma ex pleomorphic adenoma (CXPA). Tumour tissues from 40 CXPA patients diagnosed between 1960 and 2014 were obtained. Patient samples were divided into two groups (non-invasive tumours, n=10; and frankly invasive tumours, n=30). Each group was further divided into two subgroups (metastatic tumours and non-metastatic tumours). Immunohistochemistry for MEC markers (α-SMA, CALPONIN, and p63) was performed, and the number and distribution of MECs was quantified. For non-invasive CXPAs, non-metastatic cases (n=8) displayed a significant enrichment in CALPONIN(+) and α-SMA(+) MECs, but not p63(+) MECs, compared with metastatic cases (n=2). Likewise, for frankly invasive CXPAs (n=30), non-metastatic cases showed a significant enrichment for α-SMA(+), CALPONIN(+), and p63(+) MECs compared with metastatic cases (n=15). We demonstrate that non-invasive CXPAs have the potential for metastasis. Furthermore, the tumour capsule may not be the only barrier preventing invasion and metastasis, as a significant reduction in numbers of myoepithelial cells correlates with invasion and metastasis in CXPA patients.



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Complete Ectopia Cordis: A Case Report and Literature Review

Ectopia cordis is a congenital heart exposure defined as complete or partial protrusion of heart through ventral defect in the thoracoabdominal wall alone or with other viscera in cases of pentalogy of Cantrell. This condition was first described by Haller et al. in 1706; since then many advances have been made. Diagnosis of ectopia cordis is done prenatally in well-equipped health facility by antenatal ultrasound scan so that early diagnosis and management plan can be initiated. The index case was delivered to uneducated rural family and admitted at 3 days of life and survived for seven days, even though most literatures state that majority died within four days even with surgery. So, in view of this, we presented this case report to deliberately draw the attention of paediatrician/obstetrician to the fact that even though this condition is rare, proactive search and diagnosis should be made and early treatment should be instituted, so that such a child may be salvaged.

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Clinical phenotypes in asthma during childhood

Abstract

In the 21st century, the heterogeneity of asthma and allergic diseases in childhood will be characterized by multiple phenotypes related to different pathophysiologic pathways or endotypes. From a medical point of view, improved understanding of disease etiology and mechanisms will lead to optimal management including personalized targeted treatment.

This article is protected by copyright. All rights reserved.

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Necrotizing Sweet syndrome in a patient with myelodysplastic syndrome

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A Young Man With Proptosis Causing Decreased Visual Acuity.

A Young Man With Proptosis Causing Decreased Visual Acuity.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:

Authors: Ghulmiyyah JM, Khademian ZP, Reilly BK

PMID: 28418522 [PubMed - as supplied by publisher]

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Association of Preoperative Calcium and Calcitriol Therapy With Postoperative Hypocalcemia After Total Thyroidectomy.

Association of Preoperative Calcium and Calcitriol Therapy With Postoperative Hypocalcemia After Total Thyroidectomy.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:

Authors: Maxwell AK, Shonka DC, Robinson DJ, Levine PA

Abstract
Importance: Hypocalcemia is the most common complication after total thyroidectomy and can result in prolonged hospital admissions and increased hospital charges.
Objective: To determine the effectiveness of preoperative calcium and calcitriol supplementation in reducing hypocalcemia following total thyroidectomy.
Design, Setting, and Participants: A retrospective cohort study was conducted at a tertiary care center in 65 patients undergoing total thyroidectomy by a single surgeon. Patients were divided into 2 groups: those receiving preoperative as well as postoperative supplementation with calcium carbonate, 1000 to 1500 mg, 3 times daily and calcitriol, 0.25 to 0.5 µg, twice daily, and those receiving only postoperative supplementation with those agents at the same dosages. Data on patients who underwent surgery between January 1, 2008, and December 31, 2011, were acquired, and data analyses were conducted from March through June 2012, and from October through December 2016.
Interventions: Calcium and calcitriol therapy.
Main Outcomes and Measures: Postoperative serum calcium levels and development of postoperative hypocalcemia.
Results: Of the 65 patients who underwent total thyroidectomy 27 (42%) were men; mean (SD) age was 49.7 (16.7) years. Thirty-three patients received preoperative calcium and calcitriol supplementation, and 32 patients received only postoperative therapy. In the preoperative supplementation group, 15 of 33 (45%) patients underwent complete central compartment neck dissection and 11 of 33 (33%) had lateral neck dissection, compared with 16 of 32 (50%) and 12 of 32 (38%), respectively, patients without preoperative supplementation. The mean measured serum calcium level in those without preoperative supplementation vs those with supplementation are as follows: preoperative, 9.6 vs 9.4 mg/dL (absolute difference, 0.16; 95% CI, -0.12 to 0.49 mg/dL); 12 hours postoperative, 8.3 vs 8.6 mg/dL (absolute difference, -0.30; 95% CI,  -0.63 to 0.02 mg/dL); and 24 hours postoperative, 8.4 vs 8.5 mg/dL (absolute difference, -0.13; 95% CI, -0.43 to 0.16 mg/dL). In patients not receiving preoperative supplementation, 5 of 32 (16%) individuals became symptomatically hypocalcemic vs 2 of 33 (6%) in the preoperative supplementation group; an absolute difference of 10% (95% CI, -6.6% to 26.3%). Compared with the group not receiving preoperative supplementation, the mean [SD] length of stay was significantly shorter in the preoperative supplementation group (3.8 [1.8] vs 2.9 [1.4] days; absolute difference, -0.9; 95% CI, -1.70 to -0.105 days). Preoperative supplementation resulted in an estimated $2819 savings in charges per patient undergoing total thyroidectomy.
Conclusions and Relevance: Preoperative calcium and calcitriol supplementation, in addition to routine postoperative supplementation, was associated with a reduced incidence of symptomatic hypocalcemia, length of hospital stay, and overall charges following total thyroidectomy.

PMID: 28418509 [PubMed - as supplied by publisher]

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Association of Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid With Patient Outcomes.

Association of Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid With Patient Outcomes.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:

Authors: Lassig AAD, Joseph AM, Lindgren BR, Yueh B

Abstract
Importance: Survival rates for head and neck cancer have been relatively stable for several decades. Individualized prognostic indicators are needed to identify patients at risk for poorer outcomes.
Objective: To determine whether biomarker levels in surgical drain fluid of patients with head and neck cancer are associated with poor cancer outcomes.
Design, Setting, and Participants: This prospective cohort study enrolled patients with squamous cell carcinoma (SCC) of the oral cavity and oropharynx who required surgical treatment from April 1, 2011, to February 1, 2016, at a tertiary or academic care center. Twenty patients, including 14 with stage IV disease, had complete specimen collection. Differences in cytokine and MMP levels by disease outcomes were evaluated.
Interventions: Patients underwent surgical treatment with drain placement as dictated by the standard of care. Drain fluid samples were collected every 8 hours postoperatively until drains were removed because of clinical criteria. Levels of cytokines and matrix metalloproteinases (MMPs) were measured using electrochemiluminescent, patterned array, multiplex technology.
Main Outcomes and Measures: The primary clinical outcome measures were survival outcome and recurrence. The biomarkers measured included the cytokines basic fibroblastic growth factor, vascular endothelial growth factor isoform A, soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PIGF) and MMP-1, MMP-3, and MMP-9. Other clinical and pathologic cancer characteristics were recorded.
Results: In this cohort of 20 patients with SCC (15 men and 5 women; mean [SD] age, 63.5 [9.9] years), a significant association with recurrence was found for levels of MMP-1 (relative difference between groups, 2.78; 95% CI, 1.23-6.29), MMP-3 (relative difference between groups, 5.29; 95% CI, 2.14-13.05), and sFlt-1 (relative difference between groups, 3.75; 95% CI, 1.84-7.65). No biomarkers were associated with disease outcome. Vascular endothelial growth factor isoform A was associated with nodal metastasis (relative difference between groups, 1.98; 95% CI, 1.12-3.51), and basic fibroblastic growth factor was associated with lymphovascular invasion (relative difference between groups, 1.74; 95% CI, 1.02-2.97).
Conclusions and Relevance: In this pilot sample of patients with SCC of the oral cavity and oropharynx, MMP-1, MMP-3, and sFlt-1 levels in wound fluid were associated with poor clinical cancer outcomes in the form of recurrence. This finding is consistent with the literature of tumor microenvironment in saliva, serum, and tumor tissue biomarkers. To our knowledge, this report is the first of such findings in surgical drain fluid, an easily accessible means of cytokine measurement. Measurement of these biomarkers in surgical fluid potentially represents a novel means of assessing cancer prognosis in this population.

PMID: 28418447 [PubMed - as supplied by publisher]

http://ift.tt/2oml5Wr

Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).

Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).

JAMA Otolaryngol Head Neck Surg. 2017 Apr 13;:

Authors: Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT

PMID: 28418443 [PubMed - as supplied by publisher]

http://ift.tt/2o2GZ4Z

Efficacy and tolerance of ruxolitinib in refractory sclerodermatous chronic Graft-Versus-Host Disease

Abstract

Chronic graft-versus-host disease (cGVHD) is frequent and severe after allogeneic hematopoietic stem cell transplantation (AHSCT), with unmet therapeutic needs.¹ A recent retrospective study has shown the potential efficacy of ruxolitinib, a selective Janus Kinase (JAK) 1/2 inhibitor, for the treatment of acute (n=54) and chronic GVHD (n=41) with a 81.5% and 85.4% overall response rate for acute and chronic GVHD respectively.³ There are no specific studies evaluating the efficacy of ruxolitinib in sclerodermatous skin cGVHD, a rare and difficult-to-treat form of cGVHD.

This article is protected by copyright. All rights reserved.

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Immunostaining for Hu C/D and CD56 is useful for a definitive histopathological diagnosis of congenital and acquired isolated hypoganglionosis

Abstract

Isolated hypoganglionosis (IHG) has been proposed as a distinct entity with two subtypes: congenital IHG (CIHG) and acquired IHG (AIHG). However, due to the rarity of the disease and the lack of defining histological criteria, the concept of IHG is not widely accepted. We studied paraffin-embedded intestinal specimens from 79 patients diagnosed with Hirschsprung's disease (HD) (n = 49), CIHG (n = 25), and AIHG (n = 5) collected between January 1996 and December 2015. Histopathological diagnosis of HD, CIHG, and AIHG was confirmed by hematoxylin and eosin staining and immunohistochemical staining using Hu C/D and CD56. We evaluated (immuno)histopathological findings, counted the number of ganglion cells, and measured the size of Auerbach's plexus. Hu C/D labeled neuronal cell bodies, whereas CD56 was detected in all neuronal components. In HD, all ganglion cells in Auerbach's plexus in the normoganglionic segment (NGS) were immunoreactive for Hu C/D, whereas in the aganglionic segment (AGS), these were replaced by CD56-positive extrinsic nerve fibers and bundles. The number of ganglion cells in AIHG and CIHG was significantly lower than in the NGS of HD (p < 0.05). Auerbach's plexus was significantly smaller in CIHG (p < 0.05) but in AIHG equivalent to the NGS in HD. In summary, immunostaining for Hu C/D and CD56 is useful for definitive histopathological diagnosis of IHG.

http://ift.tt/2pAvbqn

Is tumor cellularity in primary invasive breast carcinoma of prognostic significance?

Abstract

Many methods of analysis to predict survival of invasive mammary carcinoma in the post-neoadjuvant setting utilize tumor cellularity alone or in combination with other tumor features. The goal of this study was to evaluate the prognostic value of tumor cellularity in primary non-treated carcinoma. We used 366 cases of invasive breast carcinoma to determine invasive tumor cellularity (%) by reviewing a representative excisional tumor section and correlated this with breast cancer recurrence (BCR) and overall mortality (OM). Mean patient age was 58 years (range, 21–91) and median follow-up was 87 months (range, 0.7–165). Of the cases, 25% were Nottingham grades I, 41% grade II, and 32% grade III. The Nottingham Prognostic Index (NPI) ranged from 2.06 to 6.8 (mean 3.93). Estrogen receptor was positive in 66% and negative in 25% of cases. Cellularity ranged from 2 to 99% (mean 47.6%). The OM hazard ratio increased by 1.73 for every unit increase in NPI (P < 0.00005; 95% confidence interval 1.45–2.05) The BCR hazard ratio increased by 2.011 for every unit increase in NPI BCR (P < 0.00005; 95% confidence interval 1.62–2.50). Cellularity, unadjusted for other covariates, was not significantly associated with either OM or BCR. When adjusted for NPI, cellularity still showed no significant relation to OM or BCR. The same analysis performed on estrogen receptor-positive and estrogen receptor-negative subgroups continued to show no relation between cellularity and OM or BCR. In conclusion, despite its utility in the neoadjuvant setting, we were unable to show that cellularity is predictive of survival in primary breast carcinomas.

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Prediction of distant metastases from nasopharyngeal carcinoma: Improved diagnostic performance of MRI using nodal volume in N1 and N2 stage disease

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Qi-Yong Ai, Ann D. King, Frankie K.F. Mo, Benjamin King Hong Law, Kunwar S. Bhatia, Brigette B. Ma, Darren M.C. Poon, Michael K.M. Kam
PurposeTo determine if the magnetic resonance imaging (MRI) of the head and neck can predict distant metastases (DM) from nasopharyngeal carcinoma (NPC).Methods and materialsMRI examinations of 763 NPC patients were assessed for primary tumour stage (T), nodal stage (N), primary tumour volume (PTV) and total nodal volume (NV). The association between MRI and clinical parameters were examined in DM+ and DM− patients using logistic regression and for distant metastases free survival (DMFS) using cox regression. Optimum thresholds were assessed by receiver-operating characteristics analysis, and positive predictive value (PPV) and odds ratio (OR) calculated.ResultsDistant metastases were present in 181/763 NPC patients (23.7%). Higher N stage and NV were the independent predictors of DM (p<0.001 and 0.018 respectively) and poor DMFS (p=0.001 and 0.030 respectively). Addition of NV (threshold≥32.8cm³) to the N stage improved the PPVs and ORs for DM in stage N1 (from 18.9% to 31.8% and 5.613 to 11.133 respectively) and stage N2 (from 40.4% to 60.8% and 16.189 to 36.979 respectively) but not in stage N3 (68.3% to 68.6% and 51.385 to 52.052 respectively).ConclusionMRI N stage and NV were independent predictors of DM and DMFS. The addition of NV in NPC patients with bulky N1 and N2 disease improved the ability of MRI to predict DM.



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CXCR6 gene characterization in two ethnically distinct South African populations and association with viraemic disease control in HIV-1-infected black South African individuals

Publication date: Available online 18 April 2017
Source:Clinical Immunology
Author(s): Anabela C.P. Picton, Maria Paximadis, Richard E. Chaisson, Neil A. Martinson, Caroline T. Tiemessen
CXCR6 genetic variation was described for HIV-1-uninfected black (n=41) and Caucasian (n=40) South Africans. We also investigated the CXCR6 rs2234358 and rs2234355 single nucleotide polymorphisms in HIV-1 disease control in 124 HIV-1-infected drug-naïve black individuals [elite controllers (n=11), viraemic controllers (VCs, n=30), high viral load long-term nonprogressors (HVL LTNPs, n=11) and progressors (n=72)] compared to healthy controls (HCs; n=232). The rs2234358-T allele was underrepresented in VCs (40.0%) compared to HCs (59%, P=0.006), HVL LTNPs (72.7%, P=0.012) and progressors (59%, P=0.014). The rs2234358-TT genotype was underrepresented in VCs (7%) compared to progressors (32%; OR=6.57, P=0.006) and HCs (35%; OR=7.18, P=0.001, Pbonferroni=0.034). The rs2234355-GA genotype was overrepresented in VCs (80%) compared to HCs (50.4%; OR=0.25, P=0.003) and progressors (29.17%; OR=0.10, P=3.8×10⁻⁵, Pbonferroni=0.001). The combination of rs2234355-GA in the absence of rs2234358-TT was overrepresented in VCs (80%) compared to HCs (32.6%, OR=0.12, P=1×10⁻⁶, Pbonferroni=3.4×10⁻⁵) and to progressors (16.7%; OR=0.05, P<1×10⁻⁸, Pbonferroni<1×10⁻⁷).



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Subclinical lower airways correlates of chronic allergic and non-allergic rhinitis

Summary

The upper and lower airways behave as a physiological and pathophysiological unit. Subclinical lower airways abnormalities have been described in patients with rhinitis without asthma. These are expressed as bronchial hyperreactivity, abnormalities in lung function and bronchial inflammation, likely as a result of the same phenomenon with systemic inflammatory impact that reaches both the nose and the lungs, which for unknown reasons does not always have a full clinical expression.

Patients with rhinitis are at increased risk of developing asthma; therefore most authors suggest a careful clinical evaluation and monitoring of these patients, especially if symptoms related to inflammation in the lower airways are observed.

Although current treatments, such as H1-antihistamines, intranasal steroids and allergen immunotherapy are quite effective for the management of rhinitis, it is difficult to prove their capacity to prevent asthma among subjects with rhinitis. Evidence showing that the treatment of rhinitis has a favorable impact on indicators of bronchial hyperreactivity and inflammation among subjects that have no symptoms of asthma, is more frequently described.

In this review we address the frequency and characteristics of lower airway abnormalities in subjects with rhinitis, both in pediatric and adult populations, their likely predictive value for the development of asthma and the possibilities for therapeutic intervention that could modify the risk of subjects with rhinitis towards presenting asthma.

This article is protected by copyright. All rights reserved.

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Evaluation of the Reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and the Cutaneous Assessment Tool Binary Method (CAT-BM) in Juvenile Dermatomyositis Among Pediatric Dermatologists, Rheumatologists, and Neurologists

Abstract

Background

The Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and Cutaneous Assessment Tool-Binary Method (CAT-BM) have been shown to be reliable and valid outcome measures to assess cutaneous disease in adult dermatomyositis (DM) and juvenile DM (JDM), respectively.

Objective

This study compared the CDASI and CAT-BM for use by pediatric dermatologists, pediatric rheumatologists, and pediatric neurologists in patients with JDM.

Methods

Five pediatric dermatologists, five pediatric rheumatologists, and five pediatric neurologists each evaluated 14 patients with JDM using the CDASI, CAT-BM, and skin Physician Global Assessment (PGA) scales. Inter-rater, intra-rater reliability, construct validity, and completion time were compared.

Results

Inter-rater reliability for CDASI activity and damage scores was good to moderate for pediatric dermatologists and rheumatologists, but poor for pediatric neurologists. The inter-rater reliability for CAT-BM activity scores was moderate for pediatric dermatologists and rheumatologists, but poor for pediatric neurologists and poor across all specialties for damage scores. Intra-rater reliability for the CDASI and CAT-BM activity and damage scores was moderate to excellent for pediatric dermatologists, rheumatologists, and neurologists. Strong associations were found between skin PGA activity and damage scores and CDASI or CAT-BM activity and damage scores, respectively (p<0.002). The CDASI had a mean completion time of 5.4 minutes versus the CAT-BM of 3.1 minutes.

Conclusions

Our data confirm the reliability of the CDASI activity and damage scores and the CAT-BM activity scores when used by pediatric dermatologists and rheumatologists in assessing JDM. Significant variation existed in the pediatric neurologists' scores.

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Analysis of an electrical impedance spectroscopy system in short-term digital dermoscopy imaging of melanocytic lesions

Abstract

Background

Electrical impedance spectroscopy (EIS) is a non-invasive diagnostic technique that measures tissue impedance.

Objectives

This prospective study, conducted at 2 centres in Australia, aimed to evaluate the effect of adding an EIS measurement at baseline to suspicious melanocytic lesions undergoing routine short-term sequential digital dermoscopy imaging (SDDI)

Methods

Patients presented with suspicious melanocytic lesions that were eligible for short-term SDDI (with no clear feature of melanoma on dermoscopy). The EIS measurement was performed at the first visit following the dermoscopic photography. Normally, an EIS score of ≥4 is considered positive whereas this protocol investigated a higher cut-off in combination with SDDI. When the EIS score was ≥7 the lesion was excised immediately due to the high risk of melanoma. Lesions with a score <7 were monitored with standard SDDI over a 3 month period.

Results

From a total of 160 lesions analysed, 128 of 154 benign lesions received an EIS score of 0-6, giving a specificity of the EIS method for the diagnosis of melanoma of 83.1% (95% CI:76.3-88.7). Five of the six melanomas found in this study had an EIS score ≥7, with a sensitivity for melanoma diagnosis of 83.3% (95% CI:35.9-99.6).

When EIS 0-6 lesions were subsequently followed up with SDDI, one additional melanoma was detected (EIS=6) giving the sensitivity for the diagnosis of melanoma overall of 100%: 95% CI:54.1-100 (6/6 MM excised) and the specificity 69.5%: 95% CI:61.5 to 76.6 (107/154 benign lesions not excised).

Conclusion

If utilizing a protocol where an EIS score ≤3 requires no SDDI and ≥7 requires immediate excision this reduced the need for SDDI by 46.9% (75/160): 95% CI:39.0-54.9.

This article is protected by copyright. All rights reserved.

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Fluorescence-Advanced-Videodermatoscopy (FAV): a new method for in-vivo skin evaluation

Abstract

Dermatoscopy is a non-invasive technique that allows a rapid and magnified in-vivo observation of the skin ^1–3. Manual dermatoscopy uses optical systems that work by modifying the cutaneous air-tissue optical interference ¹. Videodermatoscopy, on the other hand, is supported by digital systems allowing an image acquisition at higher magnification.

This article is protected by copyright. All rights reserved.

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The factor structure of dental fear

There is limited empirical information as to whether or how stimuli associated with dental fear can be classified into distinct subtypes. The purpose of the current study was to develop a descriptive framework for the classification of dental fear. Data were collected using a survey among Dutch twin families (n = 11,771). The sample was randomly divided into two subsamples of, respectively, 5,920 and 5,851 individuals. An exploratory factor analysis (EFA) was performed on the first subsample to delineate the multidimensional structure of a set of 28 dental-fear-provoking objects and situations. The second sample was used to confirm the newly derived model using confirmatory factor analysis (CFA). The EFA yielded a three-factor solution with 70.7% explained variance pertaining to: (i) invasive treatment or pain; (ii) losing control; and (iii) physical sensations. The CFA showed an acceptable fit to the data, thereby confirming the stability of the three-factor structure. There are at least three different subtypes of dental fear. As these subtypes require a different treatment approach in clinical practice, it could be important to assess the severity of patients' fear response along these three dimensions.

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