Vaccine allergy

Publication date: Available online 27 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Philip Hei Li, Annette Wagner, Ryszard Rutkowski, Krzysztof Rutkowski




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Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis

Publication date: Available online 27 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jessica W. Hui, Jason Ong, James J. Herdegen, Hajwa Kim, Christopher D. Codispoti, Vahid Kalantari, Mary C. Tobin, Robert P. Schleimer, Pete S. Batra, Phillip S. LoSavio, Mahboobeh Mahdavinia
BackgroundIt is widely known that patients with chronic rhinosinusitis (CRS) commonly experience sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population.ObjectiveTo identify the risk factors for OSA in CRS to determine who should be screened for OSA among patients with CRS.MethodsWe evaluated a large cohort of patients with confirmed diagnostic criteria for CRS. Patient medical records were reviewed to identify those with OSA confirmed by overnight polysomnography. Records were further reviewed for demographic information (age, sex, race, and ethnicity), body mass index, and medical history, including the presence of nasal polyps, asthma, aspirin-exacerbated respiratory disease, allergic rhinitis, and eczema. The number of endoscopic sinus operations, duration of CRS, presence of subjective smell loss, and computed tomography Lund-Mackay score were also ascertained.ResultsA total of 916 patients with CRS were included in the study. Implementation of a multivariable regression model for identifying adjusted risk factors revealed that African American patients had a significantly higher risk for OSA than white patients, with an adjusted odds ratio of 1.98 (95% confidence interval, 1.19–3.29). Furthermore, patients with CRS without nasal polyps were at higher risk for OSA, with an odds ratio of 1.63 (95% confidence interval, 1.02–2.61) compared with patients with CRS with nasal polyps.ConclusionAfrican American patients with CRS were at higher risk for OSA compared with white patients, and this patient group needs to be screened for OSA.



http://ift.tt/2pf0Lt5

Systemic reaction to timothy grass pollen sublingual immunotherapy

Publication date: Available online 27 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anita Wasan, Anil Nanda




http://ift.tt/2oRX8pv

Cariogenic properties of Streptococcus mutans clinical isolates with sortase defects

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Jinthana Lapirattanakul, Yukiko Takashima, Pornpen Tantivitayakul, Thaniya Maudcheingka, Pattarawadee Leelataweewud, Kazuhiko Nakano, Michiyo Matsumoto-Nakano
ObjectiveIn Streptococcus mutans, a Gram-positive pathogen of dental caries, several surface proteins are anchored by the activity of sortase enzyme. Although various reports have shown that constructed S. mutans mutants deficient of sortase as well as laboratory reference strains with a sortase gene mutation have low cariogenic potential, no known studies have investigated clinical isolates with sortase defects. Here, we examined the cariogenic properties of S. mutans clinical isolates with sortase defects as well as caries status in humans harboring such defective isolates.DesignSortase-defective clinical isolates were evaluated for biofilm formation, sucrose-dependent adhesion, stress-induced dextran-dependent aggregation, acid production, and acid tolerance. Additionally, caries indices of subjects possessing such defective isolates were determined.ResultsOur in vitro results indicated that biofilm with a lower quantity was formed by sortase-defective as compared to non-defective isolates. Moreover, impairments of sucrose-dependent adhesion and stress-induced dextran-dependent aggregation were found among the isolates with defects, whereas no alterations were seen in regard to acid production or tolerance. Furthermore, glucan-binding protein C, a surface protein anchored by sortase activity, was predominantly detected in culture supernatants of all sortase-defective S. mutans isolates. Although the sortase-defective isolates showed lower cariogenic potential because of a reduction in some cariogenic properties, deft/DMFT indices revealed that all subjects harboring those isolates had caries experience.ConclusionsOur findings suggest the impairment of cariogenic properties in S. mutans clinical isolates with sortase defects, though the detection of these defective isolates seemed not to imply low caries risk in the subjects harboring them.



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The effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Frank Lippert
ObjectiveThe aim was to investigate the effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation (EFU) under pH cycling conditions.DesignHuman enamel specimens were demineralized at 37°C for 24h using a pH 5.0 solution containing 50mM lactic acid and 0.2% Carbopol 907 which was 50% saturated with respect to hydroxyapatite. Lesions were assigned to nine treatment groups (n=16) based on Knoop surface microhardness indentation length.Treatmentaqueous solutions were: placebo, 11.9mM sodium fluoride (F), 23.8mM sodium fluoride (2×F), 1.1mM strontium chloride hexahydrate (Sr), 1.1mM F theobromine, Sr+theobromine, F+Sr, F+theobromine, F+Sr+theobromine. Lesions were pH cycled for 5d (daily protocol: 3×1min-treatment; 2×60min-demineralization; 4×60min & overnight-artificial saliva). Knoop indentation length was measured again and%surface microhardness recovery (%SMHr) calculated. EFU was determined using the acid-etch technique. Data were analysed using ANOVA.ResultsModel showed fluoride dose-response for both variables (2×F>F>placebo). For%SMHr, F+Sr+/−theobromine resulted in more rehardening than F, however less than 2×F. F+theobromine was similar to F. For EFU, F+Sr was inferior to F, F+theobromine and F+Sr+theobromine which were similar and inferior to 2×F. In absence of fluoride, Sr, theobromine or Sr+theobromine were virtually indistinguishable from placebo and inferior to F.ConclusionsIt can be concluded that a) strontium aids rehardening but not EFU and only in presence of fluoride; b) theobromine does not appear to offer any anti-caries benefits in this model; c) there are no synergistic effects between strontium and theobromine in the presence or absence of fluoride.



http://ift.tt/2oHHSjC

Cariogenic properties of Streptococcus mutans clinical isolates with sortase defects

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Jinthana Lapirattanakul, Yukiko Takashima, Pornpen Tantivitayakul, Thaniya Maudcheingka, Pattarawadee Leelataweewud, Kazuhiko Nakano, Michiyo Matsumoto-Nakano
ObjectiveIn Streptococcus mutans, a Gram-positive pathogen of dental caries, several surface proteins are anchored by the activity of sortase enzyme. Although various reports have shown that constructed S. mutans mutants deficient of sortase as well as laboratory reference strains with a sortase gene mutation have low cariogenic potential, no known studies have investigated clinical isolates with sortase defects. Here, we examined the cariogenic properties of S. mutans clinical isolates with sortase defects as well as caries status in humans harboring such defective isolates.DesignSortase-defective clinical isolates were evaluated for biofilm formation, sucrose-dependent adhesion, stress-induced dextran-dependent aggregation, acid production, and acid tolerance. Additionally, caries indices of subjects possessing such defective isolates were determined.ResultsOur in vitro results indicated that biofilm with a lower quantity was formed by sortase-defective as compared to non-defective isolates. Moreover, impairments of sucrose-dependent adhesion and stress-induced dextran-dependent aggregation were found among the isolates with defects, whereas no alterations were seen in regard to acid production or tolerance. Furthermore, glucan-binding protein C, a surface protein anchored by sortase activity, was predominantly detected in culture supernatants of all sortase-defective S. mutans isolates. Although the sortase-defective isolates showed lower cariogenic potential because of a reduction in some cariogenic properties, deft/DMFT indices revealed that all subjects harboring those isolates had caries experience.ConclusionsOur findings suggest the impairment of cariogenic properties in S. mutans clinical isolates with sortase defects, though the detection of these defective isolates seemed not to imply low caries risk in the subjects harboring them.



http://ift.tt/2oHHT7a

The effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Frank Lippert
ObjectiveThe aim was to investigate the effects of fluoride, strontium, theobromine and their combinations on caries lesion rehardening and fluoridation (EFU) under pH cycling conditions.DesignHuman enamel specimens were demineralized at 37°C for 24h using a pH 5.0 solution containing 50mM lactic acid and 0.2% Carbopol 907 which was 50% saturated with respect to hydroxyapatite. Lesions were assigned to nine treatment groups (n=16) based on Knoop surface microhardness indentation length.Treatmentaqueous solutions were: placebo, 11.9mM sodium fluoride (F), 23.8mM sodium fluoride (2×F), 1.1mM strontium chloride hexahydrate (Sr), 1.1mM F theobromine, Sr+theobromine, F+Sr, F+theobromine, F+Sr+theobromine. Lesions were pH cycled for 5d (daily protocol: 3×1min-treatment; 2×60min-demineralization; 4×60min & overnight-artificial saliva). Knoop indentation length was measured again and%surface microhardness recovery (%SMHr) calculated. EFU was determined using the acid-etch technique. Data were analysed using ANOVA.ResultsModel showed fluoride dose-response for both variables (2×F>F>placebo). For%SMHr, F+Sr+/−theobromine resulted in more rehardening than F, however less than 2×F. F+theobromine was similar to F. For EFU, F+Sr was inferior to F, F+theobromine and F+Sr+theobromine which were similar and inferior to 2×F. In absence of fluoride, Sr, theobromine or Sr+theobromine were virtually indistinguishable from placebo and inferior to F.ConclusionsIt can be concluded that a) strontium aids rehardening but not EFU and only in presence of fluoride; b) theobromine does not appear to offer any anti-caries benefits in this model; c) there are no synergistic effects between strontium and theobromine in the presence or absence of fluoride.



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Lymphoepithelioma-like carcinoma of the upper urinary tract

Abstract

In this report, we summarized the clinicopathologic features of ten cases of lymphoepithelioma-like carcinoma (LELC) of the upper urinary tract (ureter n = 6; renal pelvis n = 4), a rare variant of urothelial cancer characterized by a malignant epithelial component densely infiltrated by lymphoid cells. The initial diagnosis was made on radical nephrectomy in five cases, nephroureterectomy in three cases, and ureterectomy in two others. Four patients had pathologic stage T1 (n = 2) or T2 (n = 2) tumors, and six patients had stage pT3 disease. Microscopically, all tumors contained pure (n = 3) or predominant (n = 7) LELC, which composed 60 to 80% of the entire tumor. Non-LELC tumor component was adenocarcinoma (n = 2), spindle cell carcinoma (n = 1), or high-grade conventional urothelial carcinoma (n = 4). The LELC component was characterized by indistinct cytoplasmic borders and a syncytial growth pattern. Immunohistochemical staining showed LELC to be positive for cytokeratin AE1/AE3, CK7, CK34ßE12 (rare cells), CK5/6 (rare cells), and CK20 (rare cells); rare cells were p40 positive. GATA 3 was positive in all cases in a variable proportion of cells (20–80%). Lymphoid markers showed a polyclonal proliferation of predominant T cells admixed with B cells. In situ hybridization for the HPV genome was negative in all ten cases. Survival analysis showed no differences between LELC and conventional upper urinary tract urothelial carcinoma, pT classification being the only significant prognostic parameter. Morphologic recognition and distinction from other (non-)neoplastic lesions with prominent lymphoid stroma are critical for its clinical management.

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Adaptation of the vertical vestibulo-ocular reflex in cats during low-frequency vertical rotation

Publication date: Available online 28 April 2017
Source:Auris Nasus Larynx
Author(s): Hiroaki Fushiki, Motoyoshi Maruyama, Hideo Shojaku
ObjectiveWe examined plastic changes in the vestibulo-ocular reflex (VOR) during low-frequency vertical head rotation, a condition under which otolith inputs from the vestibular system are essential for VOR generation.MethodsFor adaptive conditioning of the vertical VOR, 0.02Hz sinusoidal pitch rotation for one hour about the earth's horizontal axis was synchronized with out-of-phase vertical visual stimulation from a random dot pattern.ResultsA vertical VOR was well evoked when the upright animal rotated around the earth-horizontal axis (EHA) at low frequency due to the changing gravity stimulus and dynamic stimulation of the otoliths. After adaptive conditioning, the amplitude of the vertical VOR increased by an average of 32.1%.ConclusionOur observations showing plasticity in the otolithic contribution to the VOR may provide a new strategy for visual-vestibular mismatch training in patients with otolithic disorders. This low-frequency vertical head rotation protocol also provides a model for investigating the mechanisms underlying the adaptation of VORs mediated by otolith activation.



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The effect of terrain on entheseal changes in the lower limbs

Abstract

One of the main factors involved in entheseal changes (EC) aetiology may be related to the physiological limits of biomechanical loading fixed during bone development, such that higher load during childhood and the adolescent growth spurt leads to a lower frequency of EC during adulthood. In this sense, it is possible that ECs may be related to overloading beyond an individual's normal physiological limits as established during childhood and adolescence.

This meta-analysis tested this aetiological possibility by studying the influence of terrain on the entheses of the lower extremities. The hypothesis is that individuals who inhabited rugged terrain have lower EC than those living in flat terrain. This is because biomechanical loads associated with rugged terrain will lead to a higher normal capacity (defined during skeletal development) mitigating the probability of overloading compared to those living in flat terrain who will therefore have a higher frequency of ECs. To test this, papers reporting EC frequencies in the lower limbs were analysed alongside the local terrain. Terrain was defined into two categories: flat or rugged based on altimetry profile, i.e. the average elevation gains and losses along four specific paths (North-South, East-West, Northwest-Southeast, Southwest-Northeast). Odds ratios were calculated to compare rugged and flat terrain.

The overall results are consistent with the hypothesis that overloading is a factor in EC aetiology. However, when the analysis is conducted by sex and side, this general trend does not always occur. Limitations such as the lack of standardized age ranges could be affecting the outcome, i.e. older individuals have a higher frequency of ECs. The findings of this analysis suggest that the theoretical assumptions associated with the cause of ECs require further testing and evaluation.

http://ift.tt/2oHlsiD

Adaptation of the vertical vestibulo-ocular reflex in cats during low-frequency vertical rotation

We examined plastic changes in the vestibulo-ocular reflex (VOR) during low-frequency vertical head rotation, a condition under which otolith inputs from the vestibular system are essential for VOR generation.

http://ift.tt/2oHbXzZ

Fixation of fractures of the condylar head of the mandible with a new magnesium-alloy biodegradable cannulated headless bone screw

It is difficult to fix fractures of the condylar head of the mandible. Several techniques have been described which show satisfactory outcomes, but stability can be questionable, and some can cause irritation of the soft tissues. We describe a technique and first results of treating such fractures with resorbable magnesium-based headless bone screws (Magnezix® 2.7mm CS; Syntellix AG, Hanover, Germany).

http://ift.tt/2qgWO5l

Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years’ follow up

The aim was to analyse the short-term and long-term therapeutic efficacy of dextrose prolotherapy for dislocation or subluxation (hypermobility) of the temporomandibular joint (TMJ). Sixty-one patients with symptomatic hypermobility of the TMJ were included in this single-arm prospective study, in which they were each given four sessions of intra-articular and pericapsular injections six weeks apart. Each injection comprised 10% dextrose/mepivacaine solution 3ml. Clinical outcomes including severity of pain on movement according to the numerical rating scale (NRS), maximal interincisal opening, clicking, and frequency of locking were measured before treatment (T1), during treatment (T2) (just before the third session of injections), at the short-term follow-up (T3) (three months after treatment), and at the long-term follow-up (T4) (1-4 years after treatment).

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A rare complication of tonsillitis: septic arthritis of the temporomandibular joint

Septic arthritis of the temporomandibular joint (TMJ) is a rarely seen clinical condition. Such an infection may be encountered following infections in the head and neck region, with direct or haematogenous spread to the joint. This article presents the case of a patient with tonsillitis leading to septic arthritis of the TMJ and reports the results of a review of the literature.

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Innate Immune Gene Transcript Level Associated with the Infection of Macrophages with Ectromelia Virus in Two Different Mouse Strains

Viral Immunology , Vol. 0, No. 0.


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High Rate of Hepatitis B Virus Surface Antigenemia Among People Living with HIV/AIDS in Kakuri, Kaduna State, North West Nigeria

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2pdP99q

Visual analogue scale (VAS) as a monitoring tool for daily changes in asthma symptoms in adolescents: a prospective study

Success in asthma management hinges on patients' competency to detect and respond to ever-changing symptom severity. Thus, it is crucial to have reliable, simple, and sustainable methods of symptom monitoring ...

http://ift.tt/2oGjGON

Targeting Circulating Leukocytes and Pyroptosis during Ex Vivo Lung Perfusion Improves Lung Preservation.

Background: The role of the circulating leukocytes in lungs and their relationship with circulating proinflammatory cytokines during ischemia-reperfusion injury is not well understood. Using ex vivo lung perfusion (EVLP) to investigate the pathophysiology of isolated lungs, we aimed to identify a therapeutic target to optimize lung preservation leading to successful lung transplantation. Methods: Rat heart-lung blocks were placed on EVLP for 4 hours with or without a leukocyte-depleting filter (LF). Following EVLP, lung grafts were transplanted, and posttransplant outcomes were compared. Results: Lung function was significantly better in lung grafts on EVLP with a LF than in lungs on EVLP without a LF. The interleukin (IL)-6 levels in the lung grafts and EVLP perfusate were also significantly lower after EVLP with a LF. Interestingly, IL-6 levels in the perfusate did not increase after the lungs were removed from the EVLP circuit, indicating that the cells trapped by the LF were not secreting IL-6. The trapped cells were analyzed with flow cytometry to detect apoptosis and pyroptosis; 26% were pyroptotic (Caspase-1-positive). After transplantation, there was better graft function and less inflammatory response if a LF was used or a caspase-1 inhibitor was administered during EVLP. Conclusions: Our data demonstrated that circulating leukocytes derived from donor lungs, and not circulating proinflammatory cytokines substantially impaired the quality of lung grafts through Caspase-1 induced pyroptotic cell death during EVLP. Removing these cells with a LF and/or inhibiting pyroptosis of the cells can be a new therapeutic approach leading to long-term success following lung transplantation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Chronic AMR in Liver Transplant: Validation of the 1-Year cAMR score's Ability to Determine Long-Term Outcome.

Background: A proposed chronic antibody-mediated rejection (AMR) score has recently predicted 50%10-year death censored allograft loss in patients with Donor Specific Alloantibodies (DSA) Mean Florescence Intensity (MFI) >10 000 and requires confirmation in patients with lower MFI (1000-10 000). Methods: All patients who underwent liver transplantation (LT) from 1/00-4/09, had DSA (MFI >=1000) in serum 10-14 months post-LT, and had a protocolized liver biopsy were evaluated (n=230). The previously proposed chronic AMR (cAMR) score was used to risk-stratify putative chronic AMR in DSA+ patients with MFI from 1000-10 000. Results: The MFI distribution of DSA+ recipients were as follows: 66% had MFI 1000-4999, 14% had MFI 5000-10 000 and 20% had MFI >10 000. The cAMR score distribution on 1-year protocol liver biopsy was found to be: 41% had a score 27.5. MFI correlated with 1-year cAMR category (27.5, 29% vs. 42% when MFI was 1000-10 000 vs. MFI >10 000; p=0.047). In patients with a cAMR score 13 (p=0.004) in DSA+ patients with MFI 1000-10 000. DSA MFI>10 000 vs. MFI 1000-10 000 at 1-year was also more likely to persist at 5-years (95% vs. 68%; p

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mTOR Inhibition to Prevent Posttransplant Malignancies - Don't Stop Believin'.

No abstract available

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High tacrolimus clearance is a risk factor for acute rejection in the early phase after renal transplantation.

Background: Patients with high tacrolimus clearance eliminate more drug within a dose interval compared to those with low clearance. Delays in dosing time will result in transient periods of lower concentrations in high versus low clearance patients. Transient subtherapeutic tacrolimus concentrations may induce acute rejection episodes. Methods: A retrospective study in all renal transplant patients treated with tacrolimus at our centre from 2009 to 2013 was conducted. The association between individually estimated tacrolimus clearance (daily tacrolimus dose [mg]/trough concentration [[mu]g/L]) and biopsy-proven acute rejection (BPAR) the first 90 days posttransplantation was investigated. Results: In total, 638 patients treated with oral tacrolimus were included in the analysis. Eighty-five (13.3%) patients experienced BPAR. Patients were stratified into 4 groups per their estimated clearance. The patients in the high clearance group had significantly higher incidence of BPAR (20.6%) with a HR of 2.39 (95% CI; 1.30-4.40) compared to the low clearance group. Clearance estimate (as a continuous variable) showed a hazard ratio of 2.25 (95% CI; 1.70-2.99) after adjusting for other risk factors. There were no significant differences in neither trough concentrations the first week after transplantation nor time to target trough concentration between patients later experiencing BPAR or not. Conclusion: High estimated clearance is significantly associated with increased risk of BPAR the first 90 days posttransplantation, and may predict an increased risk of rejection in the early phase following renal transplantation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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A Short Term Comparison of Cartilage with Temporalis Fascia Graft Tympanoplasty in Paediatric and Adolescent Population

Abstract

To compare the anatomic and functional outcomes of the cartilage and temporalis fascia graft materials in type 1 tympanoplasty in paediatric and adolescent population. A total of 55 patients aged <18 years who required type 1 tympanoplasty were selected. 30 patients underwent cartilage palisade tympanoplasty and 25 using temporalis fascia grafts. The age, the side of the operated ear, the operative technique, pre- and post operative pure tone and impedance audiological results, and the status of the graft were noted. Graft was considered taken up if there was successful closure of tympanic membrane perforation. At the end of 6 months, the graft take rate for cartilage was 90% and for temporalis fascia it was 80% (p > 0.05). ABG closure ratio in cartilage group was 58.54 ± 23.10% and in temporalis fascia group was 56.46 ± 27.4% (p > 0.05). Pre operatively all patients had type B tympanogram in both the groups. While post operatively either type A or C curve was seen in 80% patients of cartilage and 68% patients of temporalis fascia group. Hearing outcomes and graft success rates were high in both fascia and cartilage graft groups but not significantly different.

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Surgical Outcome of Mastoid Cavity Obliteration Using Postauricular Composite Bone with Periosteum Flap

Abstract

This study was aimed to evaluate surgical outcome of patients undergoing obliteration of mastoid cavity with postauricular composite osteo-periosteal flap. This interventional study was carried out on 100 patients having unsafe CSOM from Nov. 2012 to Oct. 2014 who underwent canal wall down mastoidectomy with tympanoplasty and obliteration of cavity using composite osteo-periosteal flap. The primary outcome measure was control of suppuration and creation of dry, low-maintenance mastoid cavity, which was assessed using Merchant et al. grading system. At the end of 1 year follow-up, 89% patients had Grade 0 summary score while Grade 3 which was considered as failure of control of infection was not obtained in any patient during the entire follow-up period. Mastoid cavity obliteration using composite osteo-periosteal flap is an effective technique to avoid cavity problems.

http://ift.tt/2ppo55z

Cardiovascular risk in patients with rheumatoid arthritis

Abstract

Substantial epidemiologic data have shown an increased risk of cardiovascular (CV) disease in rheumatoid arthritis (RA) patients. Traditional CV risk factors may partly contribute to CV disease in RA; however, current evidence underlines the important role of inflammation in the pathogenesis of atherosclerosis and amplification of CV risk. Interplays between inflammation and lipid metabolism in the development of atherosclerosis have been established by recent scientific advances. Atherosclerosis is currently viewed as an inflammatory disease, and modifications of lipoproteins during inflammation accelerate atherogenesis. The role of inflammation in the increased CV risk in RA has been further demonstrated by the CV protective effect of methotrexate and TNF antagonists, particularly in patients responding to these treatments. The management of CV risk in RA should include the use of effective disease-modifying anti-rheumatic drugs to control disease activity and the treatment of traditional CV risk factors.

http://ift.tt/2qnH5AF

Eosinophilic Otitis Media: the Aftermath of Eosinophil Extracellular Trap Cell Death

Abstract

Purpose of Review

Eosinophilic otitis media (EOM) is a refractory disease characterized by the accumulation of eosinophils in middle ear effusion and mucosa. We summarize current knowledge regarding the clinical characteristics and management of EOM. Although eosinophil activation in inflamed foci is involved in the pathogenesis of EOM, little is known about the fate of the eosinophils and aftermath of their cell death. We discuss the possibility that eosinophils undergo non-apoptotic cell death that worsens tissue damage and increases effusion viscosity.

Recent Findings

Unlike chronic otitis media, EOM is strongly associated with an allergic background. Corticosteroids are currently the only effective pharmacological treatment, and surgical intervention is often required. Mucosal eosinophils infiltrate extensively into the middle ear cavity where they are stimulated by locally produced activators including interleukin-5 and eotaxin. The eosinophils undergo cytolysis in the effusion, which represents a major fate of activated eosinophils in vivo. Recent data revealed cytolysis could be renamed as extracellular trap cell death (ETosis). ETosis represents suicidal cell death involving total cell degranulation and development of sticky chromatin structures (extracellular traps (ETs)). The characteristics of eosinophil- and neutrophil-derived ET polymers might contribute to the difference in viscosity of secretions between EOM and common chronic otitis media.

Summary

The extracellular products remaining after eosinophil ETosis are an important aspect of EOM pathology. The concept of ETosis also has novel implications for potential therapeutic modalities in various eosinophilic disorders.

http://ift.tt/2oTE1fl

Bioprinting of Biomimetic Skin containing Melanocytes

Abstract

This study reports a three-dimensional (3D) bioprinting technique that is capable of producing a full-thickness skin model containing pigmentation. Multiple layers of fibroblasts (FB)-containing collagen hydrogel precursor were printed and crosslinked through neutralization using sodium bicarbonate, constituting the dermal layer. Melanocytes (MC) and keratinocytes (KC) were sequentially printed on top of the dermal layer to induce skin pigmentation upon subsequent air-liquid interface culture. Histological analysis was performed not only to confirm the formation of distinct skin layers, but also to identify the presence of pigmentation. The bioprinted skin structure showed the dermal and epidermal layers as well as the terminal differentiation of the KC that formed the stratum corneum. Moreover, the MC-containing epidermal layer showed freckle-like pigmentations at the dermal-epidermal junction, without the use of external ultraviolet light or chemical stimuli. The presented method offers the capability of producing engineered ephelides in biomimetic skin, thus rendering 3D bioprinting techniques as productive on-demand options for the creation of skin models available for therapeutic or research use.

This article is protected by copyright. All rights reserved.

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PKCι is a target of 7,8,4’-trihydroxyisoflavone for the suppression of UVB-induced MMP-1 expression

http://ift.tt/2oTP3Bi

Genetics and other factors in the aetiology of female pattern hair loss

Abstract

Pattern hair loss is the most common form of hair loss in both women and men. Male pattern hair loss, also termed male androgenetic alopecia (M-AGA), is an androgen-dependent trait that is predominantly genetically determined. Androgen-mediated mechanisms are probably involved in FPHL in some women but the evidence is less strong than in M-AGA; and other non-androgenic pathways, including environmental influences, may contribute to the aetiology. Genome-wide association studies (GWASs) have identified several genetic loci for M-AGA and have provided better insight into the underlying biology. However, the role of heritable factors in female pattern hair loss (FPHL) is largely unknown. Recently published studies have been restricted to candidate gene approaches and could not clearly identify any susceptibility locus/gene for FPHL but suggest the aetiology differs substantially from that of M-AGA. Hypotheses about possible pathomechanisms of FPHL as well as the results of the genetic studies performed to date are summarized.

This article is protected by copyright. All rights reserved.

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Syndecan-1 regulates dendritic cell migration in cutaneous hypersensitivity to haptens

Abstract

In human dendritic cells (DC), we previously demonstrated in vitro that syndecan-1 (SDC1) is downregulated during maturation correlating with enhanced motility.

We investigated the effects of SDC1 on DC migration in vivo during TNCB(2,4,6-trinitro-1-chlorobenzene)-induced cutaneous hypersensitivity reaction (CHS) in mice.

We show that DC in SDC1-deficient mice migrated faster and at a higher rate to lymph nodes draining the hapten-painted skin. Adoptive transfer of SDC1-deficient hapten- and fluorochrome-labelled DC into wild type (WT) mice led to increased and faster migration of DC to paracortical lymph nodes, and to a stronger CHS compared to WT DC. In SDC1-/- mice, CCR7 remains longer on the DC surface within the first 15 min maturation (or: after LPS-induced maturation). In addition, a time-dependent up-regulation of CCL2, CCL3, VCAM1 and talin was found during maturation in SDC1-/- DC. However, no difference in T cell stimulating capacity of SDC1-deficient DC was found compared to WT DC. Mechanistically, SDC1-deficient DC showed enhanced migration towards CCL21 and CCL19. This may result from functional overexpression of CCR7 in SDC1-/- DC. Increased and accelerated migration of otherwise functionally intact SDC1-deficient DC leads to an exacerbated CHS. Based on our results, we conclude that SDC1 on DC negatively regulates DC migration.

This article is protected by copyright. All rights reserved.

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Pediatric Preoperative Assessment: 6 Million Missed Opportunities for Childhood Obesity Education.

No abstract available

http://ift.tt/2ptWjHg

Tetrodotoxin, Epinephrine, and Chemical Permeation Enhancer Combinations in Peripheral Nerve Blockade.

BACKGROUND: Chemical permeation enhancers (CPEs) have the potential to improve nerve blockade by site 1 sodium channel blockers such as tetrodotoxin (TTX). Here, we investigated the efficacy and toxicity of CPE-enhanced nerve blockade across a range of TTX concentrations using 2 CPEs (sodium octyl sulfate and octyl trimethyl ammonium bromide). We also tested the hypothesis that CPEs could be used to reduce the concentrations of TTX and/or of a second adjuvant drug (in this case, epinephrine) needed to achieve prolonged local anesthesia METHODS: Sprague-Dawley rats were injected at the sciatic nerve with combinations of TTX and CPEs, with and without epinephrine. Sensory and motor nerve blockade were assessed using a modified hot plate test and a weight-bearing test, respectively. Systemic and local toxicities of the different combinations were assessed. RESULTS: Addition of increasing concentrations of TTX to fixed concentrations of CPEs produced a marked concentration-dependent improvement in the rate of successful nerve blocks and in nerve block duration. CPEs did not affect systemic toxicity. At some concentrations, the addition of sodium octyl sulfate increased the duration of block from TTX plus epinephrine, and epinephrine increased that from TTX plus CPEs. The addition of epinephrine did not cause an increase in local toxicity, and it markedly reduced systemic toxicity. CONCLUSIONS: CPEs can prolong the duration of nerve blockade across a range of concentrations of TTX. CPEs could also be used to reduce the concentration of epinephrine needed to achieve a given degree of nerve block. CPEs may be useful in enhancing nerve blockade from site 1 sodium channel blockers. (C) 2017 International Anesthesia Research Society

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Measuring and Improving the Quality of Preprocedural Assessments.

BACKGROUND: Preprocedural assessments are used by anesthesia providers to optimize perioperative care for patients undergoing invasive procedures. When these assessments are performed in advance by providers who are not caring for the patient during the procedure, there is an additional layer of complexity in ensuring that the workup meets the needs of the primary anesthesia care team. In this study, anesthesia providers were asked to rate the quality of preprocedural assessments prepared by other providers to evaluate anesthesia care team satisfaction. METHODS: Quality ratings for preprocedural assessments were collected from anesthesia providers on the day of surgery using an electronic quality assurance tool from January 9, 2014 to October 21, 2014. Users could rate assessments as "exemplary," "satisfactory," or "unsatisfactory." Free text comments could be entered for any of the quality ratings chosen. A reviewer trained in clinical anesthesia categorized all comments as "positive," "constructive," or "neutral" and conducted in-depth chart reviews triggered by 67 "constructive" comments submitted during the first 3 months of data collection to further subcategorize perceived deficiencies in the preprocedural assessments. In May 2014, providers were asked to participate in a midpoint survey and provide general feedback about the preprocedural process and evaluations. RESULTS: 37,611 procedures requiring anesthesia were analyzed. Of the 17,522 (46.6%) cases with a rated preprocedural assessment, anesthesia providers rated 3828 (21.8%) as "exemplary," 13,454 (76.8%) as "satisfactory," and 240 (1.4%) as "unsatisfactory." The monthly proportion of "unsatisfactory" ratings ranged from 3.1% to 0% over the study period, whereas the midpoint survey showed that anesthesia providers estimated that the number of unsatisfactory evaluations was 11.5%. Preprocedural evaluations performed on inpatients received significantly better ratings than evaluations performed on outpatients by the preadmission testing clinic or phone program (P

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The Need for a Global Perspective on Task-Sharing in Anesthesia.

No abstract available

http://ift.tt/2qnAnL7

Optimizing Anesthesia-Related Waste Disposal in the Operating Room: A Brief Report.

Misappropriation of noncontaminated waste into regulated medical waste (RMW) containers is a source of added expense to health care facilities. The operating room is a significant contributor to RMW waste production. This study sought to determine whether disposing of anesthesia-related waste in standard waste receptacles before patient entry into the operating room would produce a reduction in RMW. A median of 0.35 kg of waste was collected from 51 cases sampled, with a potential annual reduction of 13,800 kg of RMW to the host institution, and a cost savings of $2200. (C) 2017 International Anesthesia Research Society

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Left Main Coronary Artery Dissection During Aortic Valve Replacement.

No abstract available

http://ift.tt/2qnmoov

Analysis of Production, Impact, and Scientific Collaboration on Difficult Airway Through the Web of Science and Scopus (1981-2013).

BACKGROUND: Bibliometrics, the statistical analysis of written publications, is an increasingly popular approach to the assessment of scientific activity. Bibliometrics allows researchers to assess the impact of a field, or research area, and has been used to make decisions regarding research funding. Through bibliometric analysis, we hypothesized that a bibliometric analysis of difficult airway research would demonstrate a growth in authors and articles over time. METHODS: Using the Web of Science (WoS) and Scopus databases, we conducted a search of published manuscripts on the difficult airway from January 1981 to December 2013. After removal of duplicates, we identified 2412 articles. We then analyzed the articles as a group to assess indicators of productivity, collaboration, and impact over this time period. RESULTS: We found an increase in productivity over the study period, with 37 manuscripts published between 1981 and 1990, and 1268 between 2001 and 2010 (P 9% for both WoS and Scopus, and CAGR for anesthesiology as a whole =0.64% in WoS, and =3.30% in Scopus. Furthermore, we found a positive correlation between the number of papers published per author and the number of coauthored manuscripts (P

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A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy: A Pilot Study.

BACKGROUND: Prolonged pneumoperitoneum and Trendelenburg positioning for robot-assisted radical cystectomy (RARC) are essential for optimizing visualization of the operative field, although they worsen hemodynamic and respiratory function. Our hypothesis is that the use of a valveless trocar (VT) may improve respiratory mechanics. METHODS: In this prospective, 2-arm parallel trial, patients ASA II to III undergoing RARC were randomly assigned into 2 groups: in the VT group, the capnoperitoneum was maintained with a VT; in the control group, the capnoperitoneum was maintained with a standard trocar (ST group). Inspiratory plateau pressure (Pplat), static compliance (Cstat), minute volume (MV), tidal volume (Vt), and carbon dioxide (CO2) elimination rate were recorded at these times: 15 minutes after anesthesia induction (T0), 10 minutes (T1) and 60 minutes (T2) after first robot docking, 10 minutes before first undocking (T3), 10 minutes (T4) and 60 minutes (T5) after second docking, 10 minutes before second undocking (T6), and 10 minutes before extubation (T7). The primary end point of the study was the assessment of Pplat mean value from T1 to T6. RESULTS: A total of 56 patients were evaluated: 28 patients in the VT group and 28 in the ST group. VT group had lower Pplat (means and standard error, VT group 30 [0.66] vs ST group 34 [0.66] cm H2O, with estimated mean difference and 95% confidence, -4.1 [-5.9 to -2.2], P

http://ift.tt/2qngSm0

Arterial Pressure and the Rate of Elimination of Crystalloid Fluid.

Excretion of crystalloid fluid is slow during general anesthesia. The distribution and elimination of buffered Ringer's solution were analyzed to determine whether the rate of elimination correlates with a hemodynamic factor, consciousness, patient posture, or the type of general anesthesia. Data were derived from 4 separately published studies in which 30 volunteers and 48 anesthetized patients had received 0.833 (1 series 0.667) mL/kg/min of lactated or acetated Ringer's solution over 30 minutes. Frequent measurements of the blood hemoglobin and mean urinary excretion were used as input in a kinetic analysis according to a 2-volume model and covariates, using microconstants and mixed-effects modeling software. The results show that rate of elimination of crystalloid fluid decreased with the mean arterial pressure (MAP) and patient age, but was unaffected by consciousness and inhalational or intravenous anesthesia. The elimination rate constant was 6.5 (95% confidence interval, 5.2-7.9) x 10-3 x (MAP/mean MAP)5.2 x (Age/mean Age)-1.5. The mean MAP for the 2108 data points was 81.3 mm Hg and the mean age was 40 years. The central fluid space that was expanded by infused fluid (Vc, plasma volume) increased with body weight but decreased with general anesthesia and with reductions of MAP. Simulations revealed a more than 10-fold difference in the excreted fluid volume after a theoretical 30-minute infusion, depending on whether the MAP was 50 or 100 mm Hg. In conclusion, the rate of elimination of crystalloid fluid decreased in proportion to MAP but was independent of general anesthesia and moderate-sized surgery. (C) 2017 International Anesthesia Research Society

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Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

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Outlier Practice Patterns in Mohs Micrographic Surgery

This analysis of publicly available Medicare Part B claims data studies outlier physician practices in Mohs micrographic surgery and the associated factors.

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Protective multimodal analgesia with etoricoxib and spinal anesthesia in inguinal hernia repair: a randomized controlled trial

Abstract

Background

Inguinal hernia repair is a common procedure, and can be performed under spinal anesthesia. Although adequate analgesia is crucial to postoperative recovery, the optimal protective analgesic regimen remains to be established.

Purpose

To investigate the effects of preoperative etoricoxib within a protective multimodal analgesic regimen with respect to pain control following open inguinal hernia repair.

Methods

Sixty adult patients undergoing open inguinal hernia repair participated in a single-center, randomized, double-blinded, placebo-controlled trial in a general academic medical center. The intervention group (n = 30) received 120 mg of oral etoricoxib 1 h preoperatively, and 10–12 mg bupivacaine with 25 μg fentanyl as spinal anesthesia. The control group (n = 30) received oral placebo 1 h preoperatively, and spinal anesthesia as above. Postoperative Visual Analog Scale pain scores at rest and on active straight leg raise were recorded and analyzed.

Results

Resting pain scores were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.00 vs. 4.35; 1.57 vs. 4.00; 1.24 vs. 3.76, respectively; p < 0.05). Pain scores on active straight leg raise were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.85 vs. 5.59, p < 0.01; 2.84 vs. 4.90, p < 0.05; 3.55 vs. 5.32, p < 0.05, respectively).

Conclusion

The addition of etoricoxib to spinal anesthesia as a multimodal protective regimen can improve pain control after inguinal hernia repair. The optimal dose and applicability to other operations remains to be established.

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A lateral paracarotid approach for ultrasound-guided stellate ganglion block with a linear probe

Abstract

Recent reports suggest that ultrasound-guided stellate ganglion block (SGB) is safer and more accurate than classic SGB by the using the surface anatomical landmark. However, previous reports concern the classic paratracheal approach using a small specialized curved probe, which may not be appropriate in some patients. The authors have attempted several approaches, including paratracheal, trans-thyroidal, lateral paracarotid, and lateral approaches, to find a safe and suitable method for real-time ultrasound-guided SGB using a standard high-frequency linear probe. A total of 27 injections were performed on 27 patients with sensorineural hearing loss. The lateral paracarotid out-of-plane and lateral in-plane approaches were identified as the easiest and safest methods among the four tested. In this report, we describe a new lateral paracarotid approach for ultrasound-guided SGB. An ipsilateral paratracheal short-axis transverse scan was acquired at the C6 level with a linear probe (6–13 MHz). The probe was moved laterally, scanning the thyroid, carotid artery, internal jugular vein, longus colli muscle, and the transverse process of the C6, placing the carotid artery in the middle of the view. Light pressure was applied to the probe postero-medially to displace the carotid artery medially and completely compress the internal jugular vein. The needle was inserted out-of-plane between the lateral margin of the carotid artery and Chassaignac's tubercle, traversing the collapsed internal jugular vein, and targeted between the longus colli muscle and the prevertebral fascia. A total of 4 ml of 0.2% ropivacaine was injected for each procedure after a negative aspiration test. Successful blockade was confirmed with the onset of Horner's sign. All 27 injections resulted in successful blockade with Horner's sign presenting within 5 min after injection. Side effects were minor and caused minimal discomfort; they included hoarseness and a foreign body sensation. No hematomas formed after any injections. We suggest that this new lateral paracarotid approach, with out-of plane needle insertion at the C6 tubercle under transverse scan, is a convenient and safe method for performing real-time ultrasound-guided SGB, as it provides a wide, safe space for needle passage without risking thyroid or esophageal injury.

http://ift.tt/2oFq8oV

Comparison of the incidences of hyponatremia in adult postoperative critically ill patients receiving intravenous maintenance fluids with 140 mmol/L or 35 mmol/L of sodium: retrospective before/after observational study

Abstract

Purpose

The purpose of this study was to compare the incidences of hyponatremia in adult postoperative critically ill patients receiving isotonic and hypotonic maintenance fluids.

Methods

In this single-center retrospective before/after observational study, we included patients who had undergone an elective operation for esophageal cancer or for head and neck cancer and who received postoperative intensive care for >48 h from August 2014 to July 2016. In those patients, sodium-poor solution (35 mmol/L of sodium; Na₃₅) had been administered as maintenance fluid until July 2015. From August 2015, the protocol for postoperative maintenance fluid was revised to the use of isotonic fluid (140 mmol/L of sodium; Na₁₄₀). The primary outcome was the incidence of hyponatremia (<135 mmol/L) until the morning of postoperative day (POD) 2.

Results

We included 179 patients (Na₃₅: 87 patients, Na₁₄₀: 92 patients) in the current study. The mean volume of fluid received from ICU admission to POD 2 was not significantly different between the two groups (3291 vs 3337 mL, p = 0.84). The incidence of postoperative hyponatremia was 16.3% (15/92) in the Na₁₄₀ cohort, which was significantly lower than that of 52.9% (46/87) in the Na₃₅ group (odds ratio = 0.17, 95% confidence interval 0.09–0.35, p < 0.001]. The incidences of hypernatremia, defined as serum sodium concentration >145 mmol/L, were not significantly different between the two groups.

Conclusion

In this study, the use of intravenous maintenance fluid with 35 mmol/L of sodium was significantly associated with an increased risk of hyponatremia compared to that with 140 mmol/L of sodium in adult postoperative critically ill patients.

http://ift.tt/2qfcDtz

Paravertebral block catheter breakage by electrocautery during thoracic surgery

Abstract

Advantages of thoracic paravertebral analgesia (TPA) include placement of the catheter closer to the surgical field; however, the catheter can become damaged during the operation. We experienced a case of intraoperative TPA catheter breakage that prompted us to perform an experiment to investigate possible causes. A 50-year-old male underwent a thoracoscopic lower lobectomy under general anesthesia with TPA via an intercostal approach. Following surgery, it was discovered that the catheter had become occluded, as well as cut and fused, so we reopened the incision and removed the residual catheter. From that experience, we performed an experiment to examine electrocautery-induced damage in normal (Portex™, Smith's Medical), radiopaque (Perifix SoftTip™, BBraun), and reinforced (Perifix FX™, BBraun) epidural catheters (n = 8 each). Chicken meat was penetrated by each catheter and then cut by electrocautery. In the normal group, breakage occurred in 8 and occlusion in 6 of the catheters, and in the radiopaque group breakage occurred in 8 and occlusion in 7. In contrast, breakage occurred in only 3 and occlusion in none in the reinforced group, with the 5 without breakage remaining connected only by the spring coil. Furthermore, in 7 of the reinforced catheters, electric arc-induced thermal damage was observed at the tip of the catheter. A TPA catheter for thoracic surgery should be inserted via the median approach, or it should be inserted after surgery to avoid catheter damage during surgery.

http://ift.tt/2oFALYT

An update on the management of postoperative nausea and vomiting

Abstract

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. PONV and PDNV can delay discharge and recovery and increase medical costs. The high incidence of PONV has persisted in part because of the tremendous growth in ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major operations. Pharmacological management of PONV should be tailored to the patients' risk level using the PONV and PDNV scoring systems to minimize the potential for these adverse side effects in the postoperative period. A combination of prophylactic antiemetic drugs should be administered to patients with moderate-to-high risk of developing PONV in order to facilitate the recovery process. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing PONV using prophylactic antiemetics are key elements for achieving an enhanced recovery after surgery. Strategies that include reductions of the baseline risk (e.g., adequate hydration, use of opioid-sparing analgesic techniques) as well as a multimodal antiemetic regimen will improve the likelihood of preventing both PONV and PDNV.

http://ift.tt/2qfeHS7

APHAB-Scores zur individuellen Beurteilung des Nutzens von Hörgeräteversorgungen

Zusammenfassung

Hintergrund

Der APHAB (Abbreviated Profile of Hearing Aid Benefit) ist ein Frageninventar, das mit seinen Unterskalen die subjektive Hörbeeinträchtigung in 4 unterschiedlichen Situationen misst. Ziel der vorliegenden Studie an einem sehr großen Kollektiv ist zu zeigen, wie sich die Antworten in den 4 Subskalen vor und nach einer Hörgeräteversorgung (HGV) verteilen und welcher Nutzen („benefit") sich für die Patienten ergibt. Diese Ergebnisse werden anhand der vorhandenen Literatur diskutiert.

Patienten und Methoden

Zwischen April 2013 und März 2016 wurden 35.000 APHAB-Fragebögen aus 9 Kassenärztlichen Vereinigungen ausgewertet. Für alle Unterskalen wurde der durchschnittliche APHAB-Wert vor und nach einer HGV sowie der Nutzen bestimmt und grafisch ausgewertet.

Ergebnisse

Die Ergebnisse der subjektiven Bewertungen der Hörbeeinträchtigung im APHAB vor und nach einer HGV sowie der daraus resultierende Hörgerätenutzen wurden mittels Perzentilverteilungen und Boxplots dargestellt und statistisch ausgewertet. Die Interquartilbereiche vor und nach einer HGV überlappten sich in allen APHAB-Subskalen nicht. In 3 Skalen (EC, BN, RV) lag der Median einer durchschnittlichen Hörverbesserung durch Hörgeräte bei knapp 30 Prozentpunkten, in der AV-Skala war dieser Wert leicht negativ.

Schlussfolgerung

Durch die Perzentilverteilungen dieser Untersuchung lassen sich die subjektive Beeinträchtigung eines individuellen Hörvermögens vor und nach einer HGV sowie deren Nutzen auf der Basis einer Grundgesamtheit mit sehr großer Fallzahl einordnen. Zudem wird dargestellt, warum die Darstellung von Boxplots und der daraus abgeleitete durchschnittliche Nutzen einer HGV grundsätzlich problematisch sind.

http://ift.tt/2qeMhL1

Mandibular wing osteotomy: technical modification

Publication date: Available online 28 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Coopman, T. Aerden, G. De Temmerman, C. Politis




http://ift.tt/2pcAaNf

Integration of mental health screening in the management of patients with temporomandibular disorders

Publication date: Available online 28 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): E. Yeung, A. Abou-Foul, F. Matcham, T. Poate, K. Fan
Mental health disorders such as depression or anxiety, or both, are more common in patients with temporomandibular disorders (TMD) (16%-40%) than in the general population (16%), and failure to recognise them may be detrimental to the management of TMD. Paper-based screening tools previously reported in this group require assessment by clinicians and subsequent collation of data. We describe our experience of a new system − IMPARTS (Integrating mental and physical: research training and services), which uses validated tools to identify and to monitor the progress of patients who may benefit from psychological intervention. At outpatient clinics, patients used an electronic tablet to complete the General Anxiety Disorder Questionnaire (GAD-7), the Patient Health Questionnaire (PHQ-9), the Inclusion of Oral Health Impact Profile (OHIP-14), and the Brief Pain Inventory (BPI). Data were linked directly to their electronic record to allow the results, with suggestions for treatment, to be reviewed immediately during the consultation. A total of 162 patients were included. Screening showed that referral was required in 28 (17%) with a probable major depressive disorder and 32 (20%) with a general anxiety disorder. Two (1%), who were identified as being at high risk of suicide or self-harm, were referred for immediate psychological assessment. Use of the system can aid the holistic treatment of patients with TMD through appropriate referral. Early identification of mental health problems and concurrent management are most beneficial in those who have had symptoms of TMD for up to two years, and are therefore essential.



http://ift.tt/2ppDFOC

New method of arch bar fixation

Publication date: Available online 28 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.J. Abbasi, M. Parvin




http://ift.tt/2pcoZEf

Accuracy of maxillary repositioning by computer-aided orthognathic surgery in patients with normal temporomandibular joints

Publication date: Available online 28 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Xiaozhen Lin, Biao Li, Xudong Wang, Steve G.F. Shen
Our aim was to assess the accuracy of computer-aided orthognathic surgery for maxillary repositioning in 15 patients with mandibular hyperplasia and normal temporomandibular joints (TMJ). We aligned preoperative and postoperative virtual skulls at the cranium using surface superimposition then recorded and calibrated three 3-dimensional coordinates (maxillary dental landmarks U0, 6R, and 6L) on the skulls. Errors between these preoperative and postoperative landmarks were calculated and the largest error of every patient was chosen for assessment. Landmark errors ranged from 1.00 – 2.49mm, and recording errors from −0.06 – 0.07mm. The superimposition error was mean (SD) 0.036 (0.002)mm. The accuracy of the method is acceptable in patients with a normal TMJ.



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Bone invasion by oral squamous cell carcinoma: Essential molecular alterations leading to osteoclastogenesis – A review of literature

Publication date: Available online 27 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Lauretta Vaassen, Ernst-Jan Speel, Peter Kessler
Oral squamous cell carcinoma (OSCC) is a growing problem globally. OSCC often arises in close anatomical relation to the jaws and may invade the bone. Bone invasion by OSCC has major implications on tumor staging, choice of treatment, outcome, and qualitiy of life. The difference in cortical or medullary bone invasion has implications for these factors. Treatment protocols used for cortical and medullary invasion differ worldwide. By researching possible pathways a more molecular-based clincial staging and tailor-made therapy can be useful for patients with bone invasion by OSCC. An important molecular step in bone invasion seems to be the activation of osteoclasts. Several direct and indirect pathways can activate osteoclasts. Microbial infections, hypoxia, and the immune system could be of interest.



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High prevalence of antibodies reacting to mimotopes of Simian virus 40 large T antigen, the oncoprotein, in serum samples of patients affected by non-Hodgkin lymphoma

Abstract

A new immunological investigation was carried out to study the association between non-Hodgkin lymphoma and Simian virus 40 (SV40). To this end, a new indirect ELISA was employed with two mimotopes from SV40 large T antigen (Tag), the viral oncoprotein, to analyse for specific reactions to antibodies in sera from non-Hodgkin lymphoma patients and controls, represented by healthy subjects (HS) and breast carcinoma (BC) patients. This study allowed us to assay a new sera collection from non-Hodgkin lymphoma patients (NHL, n = 254). To verify the association between NHL and SV40 Tag, two totally independent cohorts were analysed: NHL1 n = 150 and NHL2 n = 104. The epidemiological survey included sera from HS1, n = 150; HS2, n = 104 and BC, n = 78. This new indirect ELISA revealed that antibodies against SV40 Tag mimotopes are detectable in NHL1 and NHL2 sera with a prevalence of 37 and 36%, respectively. The prevalence of SV40-antibodies detected in both NHL1 and NHL2 cohorts differs statistically from controls, at 19% for HS1 (p < 0.01), HS2 (p < 0.05) and BC patients (p < 0.05). This study, carried out with an immunological assay with specific Tag oncoprotein mimotopes of Simian virus 40, reports the presence of IgG antibodies against the large Tumour antigen in non-Hodgkin lymphomas for the first time. Our immunological data with two independent NHL cohorts show a statistically significant association between Simian virus 40 Tag and non-Hodgkin lymphoma. These results suggest that SV40-positive non-Hodgkin lymphomas could be treated differently from those tested SV40-negative.

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Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials

Publication date: Available online 27 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Paolo Toti, Saverio Marchionni, Giovan-Battista Menchini-Fabris, Simone Marconcini S, Ugo Covani, Antonio Barone
PurposeGiven the lack of general consensus in the literature regarding the best method to rehabilitate partially edentulous patients with extended atrophic edentulous sites in the posterior zone of the mandible, and with a residual ridge height less than 8 mm (with or without bone augmentation procedures), the aim of this systematic review was to analyze all the relevant randomized clinical trials (RCT), and, by means of a meta-analysis of the collected data, draw some conclusions regarding the best available treatments for the rehabilitation of posterior edentulism in partially dentate mandible.Materials and MethodsAn electronic search was conducted in the MEDLINE and Cochrane Oral Health Group databases for studies published between January 2000 and September 2015 with the use of relevant keywords and hand-searching. All identified publications were screened by the authors according to the Cochrane Data Collection Form for Intervention Reviews. Collected outcomes such as biological complications, vertical ridge changes, implant and prosthetic failure were studied by subgroups analyses.ResultsAn initial search yielded 81 potential articles, of which 12 studies were chosen for inclusion. Short implants seemed to be effective in limiting incidence of the biological complications (RR: 2.822; 95% CI: 1.809-4.403; p < 0.0001) and degree of ridge height reduction (difference in means of 0.052 mm; 95% CI: 0.026-0.079 mm; p < 0.0001) when compared with long implants placed in augmented bone. Implants placed in augmented areas with the use of onlay block grafts seemed to behave worse than implants placed in the augmented sites regardless of the augmentation procedures. However, this difference did not reach statistical significance.ConclusionFindings from subgroup analyses revealed that (1) short implants placed in the posterior atrophic areas of partially edentulous mandibles were associated with superior outcomes compared with long implants in augmented bone, such as lower rate of biological complications and of peri-implant bone loss; whereas (2), there was no evidence that onlay augmentation was inferior to any of the other augmentation techniques employed.



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Lichen myxedematosus: how to reach the accurate diagnosis

http://ift.tt/2oSZmW9

MAGE-A4ᶜ¹º³²T for Multi-Tumor

Conditions:   Bladder Cancer;   Melanoma;   Head and Neck Cancer;   Ovarian Cancer;   Non-Small Cell Lung Cancer;   Esophageal Cancer;   Gastric Cancer
Intervention:   Genetic: Autologous genetically modified MAGE-A4ᶜ¹º³²T cells
Sponsor:   Adaptimmune
Not yet recruiting - verified April 2017

http://ift.tt/2qeEPfT

Radiotherapy Assessments During Intervention ANd Treatment (RADIANT)

Conditions:   Radiation Therapy;   Cancer;   Cancer of Anus;   Cancer of Bladder;   Cancer of Cervix;   Cancer of Colon;   Cancer of Rectum;   Cancer of Esophagus;   Cancer of Gallbladder;   Cancer of Liver;   Cancer of Ovary;   Cancer of Pancreas;   Cancer of Prostate;   Cancer of Kidney and Renal Pelvis;   Cancer of Stomach;   Cancer of Testis;   Cancer of Uterus;   Cancer of Uterus and Cervix;   Cancer of Kidney
Intervention:  
Sponsors:   Robert Terbrueggen;   National Cancer Institute (NCI)
Recruiting - verified April 2017

http://ift.tt/2oPNx2g

Interest of MRI in Preoperative Staging for the Laryngeal and Hypopharyngeal Cancer

Conditions:   Hypopharyngeal Carcinoma;   Laryngeal Carcinoma
Intervention:   Other: Pharyngo laryngeal MRI
Sponsor:   Hospices Civils de Lyon
Not yet recruiting - verified March 2017

http://ift.tt/2pbHEjw

{beta}hCG-secreting osteosarcoma

A 35-year-old woman presented to our institution with tender, right knee swelling. Radiological and pathological work-up revealed metastatic osteosarcoma. Prior to the initiation of chemotherapy, she underwent a routine urine pregnancy test and was surprised with a positive result. Serum beta human chorionic gonadotropin (βhCG) levels were also consistently positive and rising. No gestational sac was seen at transvaginal ultrasound. The paraneoplastic ectopic secretion of βhCG has been well described in gestational trophoblastic and gonadal tumours but has very rarely been associated with other tumour types. This patient's βhCG level was reflective of osteosarcoma activity and normalised with response to chemotherapy. The prognostic implications of βhCG expression in more diverse tumours is unclear; however, where raised, it can be used to monitor disease activity.

http://ift.tt/2oSxotS

The effect of perioperative dexamethasone dosing on post-tonsillectomy hemorrhage risk

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Yin Yiu, Justin B. Mahida, Jennifer N. Cooper, Nicole M. Elsey, Katherine J. Deans, Peter C. Minneci, Tyler B. Merrill, Joseph D. Tobias, Charles A. Elmaraghy
ObjectivesDexamethasone is currently recommended for routine prophylaxis against postoperative nausea and vomiting after tonsillectomy procedures. However, some studies have raised concern that dexamethasone use may lead to higher rates of post-tonsillectomy hemorrhage. Our objective was to determine whether higher doses of dexamethasone administered perioperatively during tonsillectomy procedures are associated with an increased risk of secondary post-tonsillectomy hemorrhage.MethodsWe conducted a retrospective review of 9843 patients who underwent tonsillectomy and received dexamethasone at our institution from January 2010 to October 2014. We compared the dose of dexamethasone administered to patients who did and did not develop secondary post-tonsillectomy hemorrhage using Mann Whitney U tests. Multivariable logistic regression models were used to evaluate the association between dexamethasone dose and post-tonsillectomy hemorrhage after adjustment for demographic and clinical characteristics.ResultsA total of 280 (2.8%) patients developed secondary post-tonsillectomy hemorrhage. Patients who developed hemorrhage tended to be older (median (interquartile range) 7 (4–11) vs. 5 (3–8) years), p < 0.001) and had undergone tonsillectomy more often for chronic tonsillitis but less often for tonsillar or adenotonsillar hypertrophy or sleep disturbances. Dexamethasone dose was significantly lower on average in patients who experienced secondary post-tonsillectomy hemorrhage (median (interquartile range) 0.19 (0.14, 0.23) mg/kg vs. 0.21 (0.17, 0.30), p < 0.001). Multivariable modeling demonstrated that the dose of dexamethasone was not significantly associated with post-tonsillectomy hemorrhage after adjustment for age.ConclusionsThere does not appear to be a dose-related increase in the risk of post-tonsillectomy hemorrhage for patients receiving dexamethasone during tonsillectomy procedures.



http://ift.tt/2oSBaTS

Foreign body aspiration in children: A study of children who lived or died following aspiration

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Maha Mohammad, Mohammad Saleem, Mohamad Mahseeri, Imad Alabdallat, Ali Alomari, Ala' Za'atreh, Ibraheem Qudaisat, Abdulrahman Shudifat, Mohammad Nasri Alzoubi
Foreign body aspiration (FBA) is a preventable cause of mortality and morbidity in children. We conducted a chart review of children who presented to a university hospital due to FBA in the period 1999–2014. Children were either managed with bronchoscopy for removal of the foreign body or died due to FBA. A total of 103 children were seen due to FBA including 27 deaths. The majority of children were boys and were less than 3 years old. Most aspirated foreign bodies were food-related, mainly peanuts. The majority of children presented with acute choking incidents, a smaller number presented with recurrent chest infections, and few children's choking incidents were unwitnessed. X-ray had a high rate of false negatives and bronchoscopy was the gold standard technique for assessment and management. Aspiration of foreign bodies is a preventable, life-threatening condition that calls for increased parent education and awareness.



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Giant Orbital Melanoma in a Heroin Abuser

Purpose: The aim of this report was to report a heroin abuser with nondiagnosed giant uveal melanoma infiltrating the orbit and prolapsing through the face. Methods: We conducted a case report of the patient with giant melanoma. Results: In March 2013, a 39-year-old male with bleeding from the right side of his face was taken to the Emergency Center of the University Hospital Bratislava by ambulance. The heroin abusing, homeless male who had never been treated before reported a 2-year history of a prolapsed, dark colored mass from his eye. Acute computed tomography confirmed a solid mass 20 × 20 cm prolapsing from the orbit. The patient rejected primary care, accepted only 1 transfusion and left the hospital. Two months later, he was admitted to the hospital due to anemia after many collapses. Liver metastasis was present. Surgical palliative therapy was not possible due to his general status. The patient started fractionated external radiotherapy with 8.0 Gy Co⁶⁰. Histopathological examination of the biopsy specimen showed malignant melanoma of the epitheloid type G2–3. The patient died in December 2013. Conclusion: Extraorbital formation of a melanoma mass may progress to a giant volume, and without treatment, led to metastases in the liver and to death after 9 months in our patient with anemia.
Case Rep Ophthalmol 2017;8:288–293

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Limbal Stem Cell-Sparing Corneoscleroplasty with Peripheral Intralamellar Tuck: A New Surgical Technique for Keratoglobus

Purpose: To describe the technique of limbal stem cell-sparing corneoscleroplasty for the management of advanced keratoglobus. Methods: A patient with bilateral advanced keratoglobus, with best-corrected visual acuity of 20/400 in the right eye and 20/200 in the left eye, underwent limbal stem cell-sparing corneoscleroplasty of the right eye. Initially, a 360-degree limbal incision with 200-μm depth was created, followed by a sublimbal tunnel dissection into the sclera, in order to conserve stem cells. Next, a limbus-to-limbus lamellar keratectomy at 200-μm depth was performed. Meanwhile, a donor corneoscleral button with preserved endothelium of the central 8 mm was fashioned. Prior to suturing the donor corneoscleral graft using a modified suturing technique to cover its scleral component, a full-thickness trephination of 8-mm diameter was completed in the central host cornea. Results: Reepithelialization occurred within the first week. No episodes of rejection, intraocular pressure spikes, or epithelial breakdown were observed postoperatively. At the 6-month follow-up, the patient had 20/70 best-corrected vision and a smooth cornea with regular astigmatism on topography. Conclusion: Limbal stem cell-sparing corneoscleroplasty is a single-step technique for restoring the structural integrity of the cornea in advanced keratoglobus while preserving the host limbal stem cells.
Case Rep Ophthalmol 2017;8:279–287

http://ift.tt/2oPqYLn

Branch Retinal Vein Occlusion, Macular Ischemia, and Intravitreal Anti-VEGF Therapy

Purpose: To report a case with ischemic macular edema (ME) due to an acute branch retinal vein occlusion (BRVO) which was treated with repeated intravitreal anti-VEGF injections. Methods: Retrospective case presentation. Results: A 66-year-old female patient was treated with repeated intravitreal anti-VEGF injections due to ischemic ME following an acute BRVO. Over a period of 2.5 years best corrected visual acuity increased from 0.06 to 0.6 (decimal notation) accompanied by a reduction in central retinal thickness from 546 to 292 µm. Overall 17 anti-VEGF injections were administered to treat repeated recurrence of ME. Macular ischemia did not worsen during this profound intravitreal anti-VEGF therapy. Conclusion: Intravitreal anti-VEGF therapy can be a beneficial treatment strategy even in ischemic ME following an acute BRVO.
Case Rep Ophthalmol 2017;8:271–278

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Environmental factors and hormones in the development of rheumatoid arthritis

Abstract

The etiopathogenesis of rheumatoid arthritis (RA) is partially understood. Genetic, environmental, and hormonal factors and their interactions are considered to play an important role on disease development. The relative contribution of environmental factors to RA development is probably larger than previously thought. The aim of this review is to appraise robust evidence about the role of environmental and hormonal risk factors for RA. We will discuss inhaled pollutants, nutritional habits, infectious, hormonal, and reproductive factors. As some of these factors are potentially modifiable, understanding their impact on RA development opens new opportunities for potential interventions and disease prevention.

http://ift.tt/2qc2Nvj

Future therapeutic targets in rheumatoid arthritis?

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation. Without adequate treatment, patients with RA will develop joint deformity and progressive functional impairment. With the implementation of treat-to-target strategies and availability of biologic therapies, the outcomes for patients with RA have significantly improved. However, the unmet need in the treatment of RA remains high as some patients do not respond sufficiently to the currently available agents, remission is not always achieved and refractory disease is not uncommon. With better understanding of the pathophysiology of RA, new therapeutic approaches are emerging. Apart from more selective Janus kinase inhibition, there is a great interest in the granulocyte macrophage-colony stimulating factor pathway, Bruton's tyrosine kinase pathway, phosphoinositide-3-kinase pathway, neural stimulation and dendritic cell-based therapeutics. In this review, we will discuss the therapeutic potential of these novel approaches.

http://ift.tt/2oQ6S4c

The meteorology of cytokine storms, and the clinical usefulness of this knowledge

Abstract

The term cytokine storm has become a popular descriptor of the dramatic harmful consequences of the rapid release of polypeptide mediators, or cytokines, that generate inflammatory responses. This occurs throughout the body in both non-infectious and infectious disease states, including the central nervous system. In infectious disease it has become a useful concept through which to appreciate that most infectious disease is not caused directly by a pathogen, but by an overexuberant innate immune response by the host to its presence. It is less widely known that in addition to these roles in disease pathogenesis these same cytokines are also the basis of innate immunity, and in lower concentrations have many essential physiological roles. Here we update this field, including what can be learned through the history of how these interlinking three aspects of biology and disease came to be appreciated. We argue that understanding cytokine storms in their various degrees of acuteness, severity and persistence is essential in order to grasp the pathophysiology of many diseases, and thus the basis of newer therapeutic approaches to treating them. This particularly applies to the neurodegenerative diseases.

http://ift.tt/2oPNaFY

The role of autoantibodies in the pathophysiology of rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation. The presence of autoantibodies in the sera of RA patients has provided many clues to the underlying disease pathophysiology. Based on the presence of several autoantibodies like rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), anti-carbamylated protein antibodies (anti-CarP), and more recently anti-acetylated protein antibodies RA can be subdivided into seropositive and seronegative disease. The formation of these autoantibodies is associated with both genetic and environmental risk factors for RA, like specific human leukocyte antigen (HLA) alleles and smoking. Autoantibodies can be detected many years before disease onset in a subset of patients, suggesting a sequence of events in which the first autoantibodies develop in predisposed hosts, before an inflammatory response ensues leading to clinically apparent arthritis. Research on the characteristics and effector functions of these autoantibodies might provide more insight in pathophysiological processes underlying arthritis in RA. Recent data suggests that ACPA might play a role in perpetuating inflammation once it has developed. Furthermore, pathophysiological mechanisms have been discovered supporting a direct link between the presence of ACPA and both bone erosions and pain in RA patients. In conclusion, investigating the possible pathogenic potential of autoantibodies might lead to improved understanding of the underlying pathophysiological processes in rheumatoid arthritis.

http://ift.tt/2oPNCDX

How to manage chronic urticaria ‘beyond’ guidelines: a practical algorithm

Abstract

Chronic urticaria (CU) is a disease characterised by pruritic weals, angio-oedema or both occurring for at least 6 weeks. It encompasses spontaneous and inducible urticarias. The national and international guidelines outline the principles of treatment. Omalizumab, an anti-immunoglobulin E monoclonal antibody has transformed the management of many severe and treatment-refractory patients. However, current UK guidance on its use does not address the needs of those with less severe disease, inducible urticarias, idiopathic histaminergic angio-oedema without weals as a presentation of CU and omalizumab non-responders. Our algorithm and a summary of the evidence to support its principles offers guidance and a more systematic targeted approach to using a range of 'off-label' agents for specific phenotypes of CU. It will be of use when guideline-recommended mast cell mediator antagonists fail to control symptoms and/or using omalizumab is ineffective, not practical or unfunded.

This article is protected by copyright. All rights reserved.

http://ift.tt/2oDx3PM

Annual hospitalisation rates for children with asthma are inversely associated with total hours of sunshine in English regions

Abstract

During childhood, exacerbation of asthma is the most common medical reason for admission to hospital in the UK. Each year 44,000 children are admitted to hospital in the UK with 40-50 children dying as a result of asthma [1]. Weather patterns and seasonality have distinct, measurable effects on the rates of hospitalisation for asthma.

This article is protected by copyright. All rights reserved.

http://ift.tt/2oSeTWd

Vaccine allergy

Vaccinations prevent 2 million to 3 million deaths annually, and 1.5 million more could be avoided with better coverage.1 Vaccinations are safe, and allergic reactions are extremely rare. In the United Kingdom, only 1 case of anaphylaxis or anaphylactoid reaction per million vaccine doses was reported between 1997 and 2003 (with no fatalities).2 However, poor understanding of common and expected adverse effects often leads to misdiagnosis. No large studies using supervised single- or split-dose or multistep administration (gold standard in drug allergy workup) have been published.

http://ift.tt/2oDyq0B

Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis

It is widely known that patients with chronic rhinosinusitis (CRS) commonly experience sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population.

http://ift.tt/2oS8udX

Systemic reaction to timothy grass pollen sublingual immunotherapy

Allergen immunotherapy is an effective way of treating allergic rhinitis and allergic asthma. It can be performed by sublingual or subcutaneous administration of allergens. Currently, tablet formulations have been approved in the United States for grass pollen and ragweed pollen.1 Even though sublingual immunotherapy (SLIT) has a better safety profile than subcutaneous immunotherapy (SCIT) with mostly local reactions, there is a risk of systemic reaction that must be considered.1 This case report discusses a systemic reaction to timothy grass (Phleum pratense) pollen tablets.

http://ift.tt/2oDvYY6

Switching From Conventional Photodynamic Therapy to Daylight Photodynamic Therapy For Actinic Keratoses: Systematic Review and Meta-analysis

A. Tomás-Velázquez, P. Redondo
Actas Dermosifiliogr.2017;108:282-92

Abstract - Full text - PDF

http://ift.tt/2oP1tcS

Update on Frontal Fibrosing Alopecia

L. Esteban-Lucía, A.M. Molina-Ruiz, L. Requena
Actas Dermosifiliogr.2017;108:293-304

Abstract - Full text - PDF

http://ift.tt/2paBeko

Clinical Efficacy and Safety of Ixekizumab for Treatment of Psoriasis

A. Azevedo, T. Torres
Actas Dermosifiliogr.2017;108:305-14

Abstract - Full text - PDF

http://ift.tt/2oPc0Vu

Chemical Peeling: A Useful Tool in the Office

M. Truchuelo, P. Cerdá, L.F. Fernández
Actas Dermosifiliogr.2017;108:315-22

Abstract - Full text - PDF

http://ift.tt/2paIEUX

Psoriasis, Metabolic Syndrome, and Systematic Reviews

M.A. Descalzo
Actas Dermosifiliogr.2017;108:323

Abstract - Full text - PDF

http://ift.tt/2oP68vi

The Rising Incidence of Melanoma and Nonmelanoma Skin Cancer Obliges Us to Persevere With Primary and Secondary Prevention Campaigns

O. Sanmartín Jimenez
Actas Dermosifiliogr.2017;108:324

Abstract - Full text - PDF

http://ift.tt/2paErkl

Understanding Patients With Chronic Urticaria Will Have an Impact on Quality of Management

A.M. Giménez Arnau
Actas Dermosifiliogr.2017;108:325

Abstract - Full text - PDF

http://ift.tt/2oOYLUS

Association of Psoriasis and Metabolic Syndrome in Latin America: A Systematic Review and Meta-Analysis

M.J.M. Rodríguez-Zúñiga, F. Cortez-Franco, E. Quijano-Gomero
Actas Dermosifiliogr.2017;108:326-34

Abstract - Full text - PDF

http://ift.tt/2pawWtB

Changes in the Incidence of Skin and Lip Cancer Between 1978 and 2007

E. Martín García, S. Arias-Santiago, S. Serrano-Ortega, A. Buendía-Eisman
Actas Dermosifiliogr.2017;108:335-45

Abstract - Full text - PDF

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Management of Chronic Spontaneous Urticaria in Routine Clinical Practice Following the EAACI/GA(2)LEN/EDF/WAO Guidelines

I. Marín-Cabañas, L. Berbegal-de Gracia, F. de León-Marrero, P. Hispán, J.F. Silvestre
Actas Dermosifiliogr.2017;108:346-53

Abstract - Full text - PDF

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Differences Between Men and Women in Chronic Scratching: A Psychodermatologic Study in Lichen Simplex Chronicus

R. Martín-Brufau, C. Suso-Ribera, C. Brufau Redondo, J. Corbalán Berná
Actas Dermosifiliogr.2017;108:354-60

Abstract - Full text - PDF

http://ift.tt/2oOYJMK

Eccrine Porocarcinoma: Patient Characteristics, Clinical and Histopathologic Features, and Treatment in 7 Cases

A. Gómez-Zubiaur, S. Medina-Montalvo, M.D. Vélez-Velázquez, I. Polo-Rodríguez
Actas Dermosifiliogr.2017;108:e27-32

Abstract - Full text - PDF

http://ift.tt/2paAjk6

Hyperkeratotic Subungual Tumor

D. Ayala, V. Puglia, E. Jordá
Actas Dermosifiliogr.2017;108:361-2

Abstract - Full text - PDF

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Nodular Peristomal Lesions

I. Latour-Álvarez, E. García-Peris, M.M. Pestana-Eliche, M. García-Bustínduy
Actas Dermosifiliogr.2017;108:363-4

Abstract - Full text - PDF

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RF- Are the New Direct-Acting Antiviral Agents Effective for Treating the Cutaneous Manifestations of Hepatitis C?

D. Morgado-Carrasco, X. Fustà-Novell, S. Podlipnik, P. Giavedoni
Actas Dermosifiliogr.2017;108:365-6

Abstract - Full text - PDF

http://ift.tt/2oPfnvr

What Lies Beneath: Acropachy Hiding Subungual Osteochondroma

M. Galán-Gutierrez, F. Ramos Pleguezuelos, R. Ruiz-Villaverde
Actas Dermosifiliogr.2017;108:367

Abstract - Full text - PDF

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Asymptomatic Hyperpigmented Lesions on the Areolas of a Pediatric Patient

E. Rodríguez-Lomba, I. Molina-López, M. Campos-Domínguez
Actas Dermosifiliogr.2017;108:368

Abstract - Full text - PDF

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Atypical Ulcerated Lesions in a Patient With Cogan Syndrome

G. Solano-López, A. Montes-Torres, E. Tomero, J. Fraga, D. De Argila, E. Daudèc)n
Actas Dermosifiliogr.2017;108:369-71

Abstract - Full text - PDF

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Pilot Study to Evaluate Postsurgical Dehiscence After Continuous Suture by Tissue Planes

J. Tercedor-Sánchez, A. Martinez-Lopez, I. Pérez-López, R. Ruiz-Villaverde
Actas Dermosifiliogr.2017;108:371-2

Abstract - Full text - PDF

http://ift.tt/2poqP38

Need to Screen for Chagas Disease and Strongyloides Infestation in Non-endemic Countries Prior to Treatment With Biologics

J. González-Ramos, M.L. Alonso-Pacheco, M. Mora-Rillo, P. Herranz-Pinto
Actas Dermosifiliogr.2017;108:373-5

Abstract - Full text - PDF

http://ift.tt/2oDz5zm

Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials

Given the lack of general consensus in the literature regarding the best method to rehabilitate partially edentulous patients with extended atrophic edentulous sites in the posterior zone of the mandible, and with a residual ridge height less than 8 mm (with or without bone augmentation procedures), the aim of this systematic review was to analyze all the relevant randomized clinical trials (RCT), and, by means of a meta-analysis of the collected data, draw some conclusions regarding the best available treatments for the rehabilitation of posterior edentulism in partially dentate mandible.

http://ift.tt/2qlMiZM

Bone invasion by oral squamous cell carcinoma: Essential molecular alterations leading to osteoclastogenesis – A review of literature

Oral squamous cell carcinoma (OSCC) is a growing problem globally. OSCC often arises in close anatomical relation to the jaws and may invade the bone. Bone invasion by OSCC has major implications on tumor staging, choice of treatment, outcome, and qualitiy of life. The difference in cortical or medullary bone invasion has implications for these factors. Treatment protocols used for cortical and medullary invasion differ worldwide. By researching possible pathways a more molecular-based clincial staging and tailor-made therapy can be useful for patients with bone invasion by OSCC.

http://ift.tt/2pFCkpT

The use of CT angiography for preoperative evaluation of large foreign body retention following penetrating trauma

Description

A 31-year-old man presented to the accident and emergency department with a penetrating injury to his left posterolateral chest wall. He was haemodynamically stable, and there was no significant bleeding from the entry point. Plain anterior radiography (figure 1) of the chest revealed a knife embedded within the extrathoracic tissues extending through the scapula, posterior to the clavicle with the tip lying in the left anterior triangle of the neck.

Figure 1

Plain anterior radiograph of the chest revealed a foreign body, with features consistent with a knife embedded within the extrathoracic tissues extending through the scapula, posterior to the clavicle with the tip lying in the left anterior triangle of the neck.

A CT angiogram with three-dimensional reconstruction was performed, given the proximity to important neurovascular structures. This revealed the anterior edge of the knife was related posteriorly...

http://ift.tt/2pshEkj

Odontogenic abscess mimicking acute dacryocystitis

A middle-aged poorly controlled diabetic man developed left-sided orbital and facial swelling several days after extraction of a left upper wisdom tooth. The clinical impression was that of acute dacryocystitis. Opening the skin above the lacrimal sac failed to reveal an inflamed sac establishing the diagnosis of deep facial cellulitis. Complete resolution occurred few weeks after systemic antibiotics and repeated dental drainage of the tooth abscess.

http://ift.tt/2qm0ySA

Crohns disease presenting as gastric outlet obstruction: a therapeutic challenge?

Isolated gastric Crohn's disease with initial presentation related to gastric outlet obstruction is an unusual clinicopathological entity. We undertake here a literature review of this rare initial presentation of isolated gastric Crohn's disease and discuss the formidable diagnostic and therapeutic challenges encountered in such patients.

http://ift.tt/2psrqCV

An interesting case of opium tea toxicity

We present an unusual cause of respiratory arrest resulting from sole ingestion of home-brewed opium tea. A 64-year-old woman was found unresponsive and in respiratory arrest by a first responder. There were no obvious signs of regular recreational drug use. On presentation to the local district general hospital, the patient was in extremis, with severe physiological and biochemical derangements. A naloxone infusion was commenced and she later made a good recovery. It was subsequently discovered that she had brewed opium tea from opium buds she had picked from a nearby commercial poppy farm, a practice she had learnt while in Afghanistan.

http://ift.tt/2qm0wtW

Erdheim-Chester disease associated with a novel, complex BRAF p.Thr599_Val600delinsArgGlu mutation

BRAF mutation testing to determine eligibility for treatment with vemurafenib was performed on archival skin lesions of a 54-year-old patient diagnosed with Erdheim–Chester disease (ECD) in 1999. Sanger sequencing of DNA extracted from a 2008 skin lesion identified two non-contiguous base substitutions in BRAF, which were shown by next-generation sequencing (NGS) to be located in the same allele. Due to its long-standing duration, molecular evolution of disease was possible; however, both Sanger and NGS of a 2000 skin lesion were unsuccessful due to the poor quality of DNA. Finally, droplet digital PCR using a probe specific for this novel mutation detected the complex BRAF mutation in both the 2000 and 2008 lesions, indicating this case to be ECD with a novel underlying BRAF p.Thr599_Val600delinsArgGlu mutation. Although well at present, molecular modelling of the mutant BRAF suggests suboptimal binding of vemurafenib and hence reduced therapeutic effectiveness.

http://ift.tt/2psapZA

A rare tumour of hand: angioleiomyoma

Angioleiomyoma is a benign tumour composed of smooth muscle and vascular tissue. Because of the paucity of smooth muscles in the hand other than tunica media of the blood vessels, its occurrence is quite rare in the hand and only few cases are reported in the English literature. We present the case of a 49-year-old man with benign painless swelling on the dorsum of hand. Differential diagnosis of ganglion cyst and tendon sheath tumour were considered. However, excision biopsy revealed angioleiomyoma. At 2-year follow-up, the patient remained asymptomatic with no evidence of recurrence.

http://ift.tt/2qlU3il

Melanoma patient response to nivolumab treatment for metastatic lung lesions: Multi-OMICS analysis in Project HOPE

Abstract

A 70-year-old woman was diagnosed with a malignant melanoma of the occipital skin which was resected; however, multiple lung metastases were detected. Nivolumab therapy was initiated and partial response was obtained. However, the patient was diagnosed with grade 2 interstitial pneumonitis. Prednisolone administration was initiated and the interstitial pneumonitis shadow disappeared. However, then a right rib metastasis was noticed and given radiation therapy. After progressive disease was obtained, the metastatic lesion was resected, and no relapse occurred until skeletal muscle metastasis was found. According to whole-exome sequencing and gene expression profiling, the rib and skeletal muscle metastatic lesions showed an upregulated expression of programmed death-ligand 1 mRNA and a high single-nucleotide variant (SNV) number. The current melanoma case is representative of a patient who responded to nivolumab therapy, and showed typical immunological markers for responders such as high PD-L1 expression and high SNV.

http://ift.tt/2popQ36

Effects of Helicobacter pylori treatment on rosacea: A single-arm clinical trial study

Abstract

Rosacea is a chronic dermatological disease. Helicobacter pylori has been discussed as one of its causative factors. In this clinical trial study, we attempted to evaluate the effect of H. pylori standard eradication protocol on the rosacea clinical course. In this single-arm clinical trial, patients ascertained to have H. pylori infection based on serological studies were assessed to examine existence of rosacea. Patients with concurrent rosacea and H. pylori infection were included in the study and underwent standard H. pylori eradication therapy. Rosacea was evaluated using the Duluth rosacea grading score at the beginning, 2 months later and at the end of the trial (day 180). Of 872 patients positive for H. pylori, 167 patients (19.15%) manifested the clinical features of rosacea. The patients with concurrent rosacea were younger (P < 0.001) and with a female sex predominance (P = 0.03) when compared with rosacea-free patients. Of 167 patients, 150 received H. pylori eradication therapy, demonstrating a 92% (138/150) cure rate. The rosacea Duluth score grading on day 0, 60 and 180 among 138 patients significantly decreased in most of the criteria except for telangiectasias (P = 0.712), phymatous changes (P = 0.535) and the existence of peripheral involvement (P = 0.431). The present study concluded that H. pylori eradication leads to improvement of rosacea.

http://ift.tt/2oDz5iD

Occult HIV infection in Japanese rupioid psoriasis

http://ift.tt/2poCMGl

Dorsal scapular artery as a recipient vessel in the vessel-depleted neck during free tissue transfer in head and neck reconstruction

Abstract

Background

The vessel-depleted neck poses a unique challenge to the microvascular surgeon. Using 3D modeling and cadaveric dissection, we describe the approach and advantages of a known but less frequently used recipient vessel, the dorsal scapular artery, during free tissue transfer.

Methods

Three patients with vessel-depleted necks required reconstruction with free tissue transfer. The dorsal scapular artery was used as a recipient vessel. Three-dimensional anatomic models were created and cadaveric dissections were performed to characterize the anatomy.

Results

The dorsal scapular artery was successfully used in 3 patients as the recipient pedicle for free tissue transfer. The vessel was identified deep in the posterior triangle after emerging through the brachial plexus. In all cases, the artery was in a previously undissected field, and had a large caliber and favorable geometry for microvascular anastomosis.

Conclusion

The dorsal scapular artery is a viable recipient vessel during head and neck reconstruction in the vessel-depleted neck.

http://ift.tt/2oDzkKK

Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: A cohort analysis and literature review

Abstract

Background

The purpose of this study was to examine swallowing-related lower cranial nerve palsy (LCNP) in oropharyngeal cancer (OPC) survivors after intensity-modulated radiotherapy (IMRT).

Methods

Patients treated with definitive IMRT (66-72 Gy) were pooled from institutional trial databases. Prospective analyses on parent trials included videofluoroscopy, clinical LCNP examination, and questionnaires pre-IMRT, 6 months post-IMRT, 12 months post-IMRT, and 24 months post-IMRT. Time-to-event and incidence of LCNP was estimated with competing risk methods. Literature review (1977-2015) summarized published LCNP outcomes.

Results

Three of 59 oropharyngeal cancer survivors with a minimum 2-year follow-up developed hypoglossal palsy ipsilateral to the index tumor (median latency 6.7 years; range 4.6-7.6 years). At a median of 5.7 years, cumulative incidence of LCNP was 5%. LCNP preceded progressive dysphagia in all cases. Published studies found median incidence of radiation-associated LCNP was 10.5% after NPC, but no OPC cancer-specific estimate.

Conclusion

Although uncommon, the potential for late LCNP preceding swallowing deterioration highlights the importance of long-term functional surveillance in OPC survivorship.

http://ift.tt/2qdzqWj

Significance of perineural invasion in locally advanced bucco alveolar complex carcinomas treated with surgery and postoperative radiation +/− concurrent chemotherapy

Abstract

Background

The purpose of this study was to evaluate prognostic factors, locoregional control, and survival in locally advanced bucco-alveolar complex cancers.

Methods

A retrospective review of 83 patients treated between January 2009 and December 2012 with bucco-alveolar complex cancers was conducted. All patients had surgery and adjuvant radiotherapy with intensity-modulated radiotherapy (IMRT) with/without concurrent chemotherapy. Survival analysis was performed using Kaplan-Meier and multivariable Cox regression model.

Results

On univariate and multivariate analysis, perineural invasion (PNI) was found to be an independent adverse risk factor. Patients with PNI-positive disease had significantly worse 2-year disease-free survival (DFS), locoregional failure free survival, and overall survival (OS) as compared to patients with PNI-negative disease (P < 0. 001, 0.001 and < 0. 001) respectively.

Conclusion

Compared with patients with PNI-negative disease, patients with PNI-positive disease had much worse outcome despite aggressive adjuvant treatment. It warrants escalation of therapy and modification in radiation portals to cover neural pathways in patients with PNI-positive disease.

http://ift.tt/2oDtxF3

Facilitating anaplastic thyroid cancer specialized treatment: A model for improving access to multidisciplinary care for patients with anaplastic thyroid cancer

Abstract

Background

Anaplastic thyroid cancer (ATC) is a highly aggressive thyroid cancer. Several treatment trials are available, but the number of eligible patients to participate is very low because of the rarity and aggressiveness of the disease.

Methods

Facilitating Anaplastic Thyroid Cancer Specialized Treatment (FAST) is a quality improvement project aimed at decreasing time from referral to disposition (scheduling of first appointment) to our institution. After identifying reasons for delays, we created a new process flow specifically for patients with ATC allowing patients to be scheduled immediately.

Results

Historical data revealed a mean referral to disposition time for patients with ATC of 8.7 days before our intervention. After the intervention, the mean referral to disposition time was reduced to 0.5 days. Participation in treatment trials for all patients with ATC was 34%.

Conclusion

Since the implementation of FAST, the access time has decreased and the number of successful referrals for ATC has increased significantly.

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Prognostic survival value of retropharyngeal lymph node involvement in sinonasal tumors: A retrospective, descriptive, and exploratory study

Abstract

Background

Sinonasal carcinomas are rare. The purpose of this study was for us to present our assessment of the effects of retropharyngeal lymph node involvement at diagnosis on patient outcomes.

Methods

Retropharyngeal lymph node involvement in 36 patients with sinonasal carcinoma was determined by radiology at initial presentation. Clinical outcome, in particular, overall survival (OS) and locoregional control, was assessed by Kaplan-Meier analysis and log-rank testing.

Results

Retropharyngeal lymph node involvement was associated with statistically significant decreased OS (P = .0066) in the patient collective. In the squamous cell carcinoma (SCC) subgroup (n = 23), decreased OS (P = .0046) and worse locoregional control (P = .0065) were observed. In these patients, decreased OS (P = .0423) and worse locoregional control (P = .0315) were also seen in the advanced tumor subgroup.

Conclusion

Retropharyngeal lymph node involvement at diagnosis is a significant prognostic factor for decreased OS and locoregional control in sinonasal carcinoma.

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