Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τρίτη 23 Μαΐου 2017

The pathogenesis of dermatomyositis

Summary

This review looks at the many different factors thought to play a role in idiopathic inflammatory myopathies (IIM), concentrating mainly on the dermatomyositis (DM) subtype. Subject areas addressed include looking at the different clinical features of IIM, paying particular attention to the skin manifestations. There is a discussion around investigations needed with their perceived value, followed by a description of the immunohistochemical findings of DM. This review goes on to address other attributing factors such as genetic associations with the different subtypes of IIM, and environmental factors including infections, ultraviolet radiation and vitamin D deficiency and drugs. Finally, the potential immunopathogenesis of DM is summarized, looking at T cells, B cells, autoantibodies, dendritic cells, cytokines and nonimmune-mediated endoplasmic reticulum stress.



http://ift.tt/2rPpnrl

Immunohistochemical localization of cannabinoid receptor 1 (CB1) in the submandibular gland of mice under normal conditions and when stimulated by isoproterenol or carbachol

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Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Wipawee Thoungseabyoun, Apussara Tachow, Sawetree Pakkarato, Atsara Rawangwong, Suthankamon Krongyut, Waraporn Sakaew, Hisatake Kondo, Wiphawi Hipkaeo
ObjectiveWe wished to investigate the subcellular localization of CB1, a receptor for the endocannabinoids in mouse submandibular glands (SMGs) under normal conditions and when stimulated by adrenergic or cholinergic agonists.Materials and methodsSMGs of both male and female adult mice were utilized for immunoblotting and immuno-light and –electron microscopic analyses. Isoproterenol and carbachol were used as adrenergic and cholinergic stimulants, respectively. SMGs were examined at 15, 30, 60 and 120min after intraperitoneal injection of these agents.ResultsSelective localization of intense immunoreactivity for CB1 in the granular convoluted ductal cells was confirmed by immunoblotting and the antigen absorption test. In SMGs of control male mice, CB1-immunoreactivity was evident on the basolateral plasma membranes, including the basal infoldings, but was absent on the apical membranes in the ductal cells. Localization and intensity of CB1-immunoreactivity were essentially the same in SMGs of female mice. The immunoreactivity was transiently localized in the apical plasmalemma of some acinar and granular ductal cells of male SMGs shortly after stimulation by isoproterenol, but not by carbachol.ConclusionThe present finding suggests that CB1 functions primarily in the basolateral membranes of the granular convoluted ductal cells of SMGs under normal conditions, and that the CB1 can function additionally in the apical membrane of acinar and granular ductal cells for modulation of the saliva secretory condition via adrenoceptors.



http://ift.tt/2qfai16

Purinergic 2X7 receptor activation regulates WNT signaling in human mandibular-derived osteoblasts

S00039969.gif

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Pimrumpai Rochanakit Sindhavajiva, Panunn Sastravaha, Mansuang Arksornnukit, Prasit Pavasant
ObjectivePurinergic 2X7 receptor (P2X7R) activation modulates in vitro mineralization by primary rat and human osteoblasts. However, the detailed mechanism of how P2X7R activation affects primary human osteoblasts remains unclear. The aim of this study was to investigate the effect of P2X7R activation on human mandibular-derived osteoblast (hMOB) differentiation.DesignPrimary human osteoblasts were obtained from non-pathologic mandibular bone from healthy patients. The hMOBs were cultured in osteogenic medium with or without 0.5–5μM 2′(3′)-O-(4-benzoyl) benzoyl-ATP (BzATP), a selective P2X7R agonist. The mRNA expression of osteogenic differentiation markers and WNT-signaling molecules was investigated by quantitative real time polymerase chain reaction. In vitro mineral deposition was determined by Alizarin Red S staining. Transfection of small interfering RNA was performed to confirm the effect of P2X7R activation. WNT/β-catenin signaling was detected by immunofluorescence staining for β-catenin.ResultsBzATP inhibited osteogenic medium-induced RUNX2 and OSX mRNA expression in hMOBs. Moreover, BzATP significantly retarded in vitro mineralization. These findings indicated that BzATP/P2X7R activation inhibited hMOB differentiation. Interestingly, reduced WNT3A mRNA expression and blockage of osteogenic medium-induced β-catenin nuclear translocation were also found. These data suggested that WNT signaling might be a target of P2X7R-regulated osteogenic differentiation. Furthermore, when recombinant human WNT3A was added to the BzATP-treated group, it rescued the reduced RUNX2 and OSX expression, and in vitro mineralization.ConclusionOur results demonstrate that P2X7R activation by BzATP inhibits hMOB differentiation. This inhibitory effect was associated with inhibition of the WNT/β-catenin signaling pathway.



http://ift.tt/2ryzeEI

Identification of oral cavity biofilm forming bacteria and determination of their growth inhibition by Acacia arabica, Tamarix aphylla L. and Melia azedarach L. medicinal plants

S00039969.gif

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Muhammad Khalid, Danial Hassani, Muhammad Bilal, Zahid Ali Butt, Muhammad Hamayun, Ayaz Ahmad, Danfeng Huang, Anwar Hussain
ObjectiveBiofilms are complex, multi-species bacterial communities that colonize the oral cavity in the form of plaque and are known to cause dental caries and periodontal disease. Present study demonstrated the potential of three selected medicinal plants against isolated and identified dental biofilm forming strains.MethodsPathogenic bacteria from dental biofilms were isolated, cultured, identified by phylogenetic analysis using PCR-based 16S ribosomal RNA (or 16S rRNA) nucleotide sequences and were analyzed for their biofilm forming capability. The antimicrobial activity of the three important medicinal plant extracts (Acacia arabica, Tamarix aphylla L. and Melia azadirachta L.) was determined against the highest biofilm forming bacteria.ResultsPhylogenetic analysis revealed that the 19 strains belonged to Proteobacteria, Firmicutes and Actinobacteria. Among the 19 isolates, eleven strains were found to possess high biofilm formation capability comparatively and antimicrobial activity assay showed that the selected plants considerably inhibited their growth. Extract from A. arabica stem had strong effect on the ability of bacteria isolated from dental carries as evident by up to 73% reduction in biofilm formation on surface pre-treated with extract from this plant. The same extract also showed tremendous biofilm cleaning potential up to 87% of the biofilm.ConclusionThe results suggested that the extracts of selected medicinal plants could be used for protection against pathogenic dental biofilm causing bacteria and attempts should be taken by pharmaceutical industries to utilize it in dental caring products.



http://ift.tt/2qeTNSV

Immunohistochemical localization of cannabinoid receptor 1 (CB1) in the submandibular gland of mice under normal conditions and when stimulated by isoproterenol or carbachol

S00039969.gif

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Wipawee Thoungseabyoun, Apussara Tachow, Sawetree Pakkarato, Atsara Rawangwong, Suthankamon Krongyut, Waraporn Sakaew, Hisatake Kondo, Wiphawi Hipkaeo
ObjectiveWe wished to investigate the subcellular localization of CB1, a receptor for the endocannabinoids in mouse submandibular glands (SMGs) under normal conditions and when stimulated by adrenergic or cholinergic agonists.Materials and methodsSMGs of both male and female adult mice were utilized for immunoblotting and immuno-light and –electron microscopic analyses. Isoproterenol and carbachol were used as adrenergic and cholinergic stimulants, respectively. SMGs were examined at 15, 30, 60 and 120min after intraperitoneal injection of these agents.ResultsSelective localization of intense immunoreactivity for CB1 in the granular convoluted ductal cells was confirmed by immunoblotting and the antigen absorption test. In SMGs of control male mice, CB1-immunoreactivity was evident on the basolateral plasma membranes, including the basal infoldings, but was absent on the apical membranes in the ductal cells. Localization and intensity of CB1-immunoreactivity were essentially the same in SMGs of female mice. The immunoreactivity was transiently localized in the apical plasmalemma of some acinar and granular ductal cells of male SMGs shortly after stimulation by isoproterenol, but not by carbachol.ConclusionThe present finding suggests that CB1 functions primarily in the basolateral membranes of the granular convoluted ductal cells of SMGs under normal conditions, and that the CB1 can function additionally in the apical membrane of acinar and granular ductal cells for modulation of the saliva secretory condition via adrenoceptors.



http://ift.tt/2qfai16

Purinergic 2X7 receptor activation regulates WNT signaling in human mandibular-derived osteoblasts

S00039969.gif

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Pimrumpai Rochanakit Sindhavajiva, Panunn Sastravaha, Mansuang Arksornnukit, Prasit Pavasant
ObjectivePurinergic 2X7 receptor (P2X7R) activation modulates in vitro mineralization by primary rat and human osteoblasts. However, the detailed mechanism of how P2X7R activation affects primary human osteoblasts remains unclear. The aim of this study was to investigate the effect of P2X7R activation on human mandibular-derived osteoblast (hMOB) differentiation.DesignPrimary human osteoblasts were obtained from non-pathologic mandibular bone from healthy patients. The hMOBs were cultured in osteogenic medium with or without 0.5–5μM 2′(3′)-O-(4-benzoyl) benzoyl-ATP (BzATP), a selective P2X7R agonist. The mRNA expression of osteogenic differentiation markers and WNT-signaling molecules was investigated by quantitative real time polymerase chain reaction. In vitro mineral deposition was determined by Alizarin Red S staining. Transfection of small interfering RNA was performed to confirm the effect of P2X7R activation. WNT/β-catenin signaling was detected by immunofluorescence staining for β-catenin.ResultsBzATP inhibited osteogenic medium-induced RUNX2 and OSX mRNA expression in hMOBs. Moreover, BzATP significantly retarded in vitro mineralization. These findings indicated that BzATP/P2X7R activation inhibited hMOB differentiation. Interestingly, reduced WNT3A mRNA expression and blockage of osteogenic medium-induced β-catenin nuclear translocation were also found. These data suggested that WNT signaling might be a target of P2X7R-regulated osteogenic differentiation. Furthermore, when recombinant human WNT3A was added to the BzATP-treated group, it rescued the reduced RUNX2 and OSX expression, and in vitro mineralization.ConclusionOur results demonstrate that P2X7R activation by BzATP inhibits hMOB differentiation. This inhibitory effect was associated with inhibition of the WNT/β-catenin signaling pathway.



http://ift.tt/2ryzeEI

Identification of oral cavity biofilm forming bacteria and determination of their growth inhibition by Acacia arabica, Tamarix aphylla L. and Melia azedarach L. medicinal plants

S00039969.gif

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Muhammad Khalid, Danial Hassani, Muhammad Bilal, Zahid Ali Butt, Muhammad Hamayun, Ayaz Ahmad, Danfeng Huang, Anwar Hussain
ObjectiveBiofilms are complex, multi-species bacterial communities that colonize the oral cavity in the form of plaque and are known to cause dental caries and periodontal disease. Present study demonstrated the potential of three selected medicinal plants against isolated and identified dental biofilm forming strains.MethodsPathogenic bacteria from dental biofilms were isolated, cultured, identified by phylogenetic analysis using PCR-based 16S ribosomal RNA (or 16S rRNA) nucleotide sequences and were analyzed for their biofilm forming capability. The antimicrobial activity of the three important medicinal plant extracts (Acacia arabica, Tamarix aphylla L. and Melia azadirachta L.) was determined against the highest biofilm forming bacteria.ResultsPhylogenetic analysis revealed that the 19 strains belonged to Proteobacteria, Firmicutes and Actinobacteria. Among the 19 isolates, eleven strains were found to possess high biofilm formation capability comparatively and antimicrobial activity assay showed that the selected plants considerably inhibited their growth. Extract from A. arabica stem had strong effect on the ability of bacteria isolated from dental carries as evident by up to 73% reduction in biofilm formation on surface pre-treated with extract from this plant. The same extract also showed tremendous biofilm cleaning potential up to 87% of the biofilm.ConclusionThe results suggested that the extracts of selected medicinal plants could be used for protection against pathogenic dental biofilm causing bacteria and attempts should be taken by pharmaceutical industries to utilize it in dental caring products.



http://ift.tt/2qeTNSV

Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: a prospective observational study

British Journal of Anaesthesia, 2016; 117(3): 309–15, DOI 10.1093/bja/aew189

http://ift.tt/2qULM6B

Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial

British Journal of Anaesthesia, 2016; 117(6): 801–11, DOI 10.1093/bja/aew338

http://ift.tt/2qa60w0

Modern hydroxyethyl starch and acute kidney injury after cardiac surgery: a prospective multicentre cohort

British Journal of Anaesthesia, 2016; 117(4): 458–63, DOI 10.1093/bja/aew258

http://ift.tt/2qUBLqd

Surgical orthodontics.

Purpose of review: The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Recent findings: Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. Summary: A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2qTf73A

Airway management during induction of anaesthesia, spontaneous ventilation (SV) and controlled mechanical ventilation (CMV), using an endotracheal tube (ETT), laryngeal mask (LM), rabbit-specific supraglottic airway device (v-gel) or facemask (FM).






Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Curcumin attenuates lipopolysaccharide/d-galactosamine-induced acute liver injury

Curcumin, a polyphenol in curry spice isolated from the rhizome of turmeric, has been reported to possess versatile biological properties including anti-inflammatory, anti-oxidant, antifibrotic, and anticancer activities. In this study, the hepatoprotective effect of curcumin was investigated in lipopolysaccharide (LPS)/d-galactosamine (d-GalN)-induced acute liver injury (ALI) in rats. Experimental ALI was induced with an intraperitoneal (ip) injection of sterile 0.9% sodium chloride (NaCl) solution containing 8μg LPS and 800mg/kg d-GalN. Curcumin was administered once daily starting three days prior to LPS/d-GalN treatment. Results indicated that curcumin could attenuate hepatic pathological damage, decrease serum ALT and AST levels, and reduce malondialdehyde (MDA) content in experimental ALI rats. Moreover, higher dosages of curcumin pretreatment inhibited NF-κB activation and reduced serum TNF-α and liver TNF-α levels induced by LPS/d-GalN ip injection. Furthermore, we found that curcumin up-regulated the expression of nuclear Nrf2 and Nrf2-dependent antioxidant defense genes including heme oxygenase-1 (HO-1), glutamate-cysteine ligase (GCLC), NAD(P)H dehydrogenase, and quinone (NQO-1) in a dose-dependent manner. Our results showed that curcumin protected experimental animals against LPS/d-GalN-induced ALI through activation of Nrf2 nuclear translocation and inhibition of NF-κB activation.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Quality indicators for the acute and long-term management of anaphylaxis: a systematic review

The quality of acute and long-term anaphylaxis management is variable and this contributes to the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes...

http://ift.tt/2qNohhw

Williams-Beuren Syndrome and Congenital Lobar Emphysema: Uncommon Association with Common Pathology?

Introduction. Congenital lobar emphysema (CLE) and Williams-Beuren Syndrome are two rare conditions that have only been reported together in a single case study. Case Presentation. We report another case of a male Caucasian newborn with nonspecific initial respiratory distress, with detection of CLE on repeat chest X-ray on Day 25 of life and concurrent ventricular septal defect, supravalvular aortic stenosis, and branch pulmonary stenosis, in whom a 7q11.23 deletion consistent with Williams-Beuren Syndrome was made. Conclusion. A diagnosis of congenital lobar emphysema should prompt further screening for congenital heart disease and genetic deletion, and further research is needed to investigate the role of elastin gene mutation in the development of the neonatal lung.

http://ift.tt/2rRMpxb

Impact of Obesity on Serum Levels of Thyroid Hormones among Euthyroid Saudi Adults

Aim of Study. To assess serum thyroid hormones levels among Saudi adults and to correlate participants' serum levels with their grades of body mass index (BMI). Methodology. A total of 278 adult subjects were recruited. Participants were categorized according to their BMI grades into normal weight (BMI

http://ift.tt/2rOL0HA

Nachruf Prof. Dr. med. Claus Walter



http://ift.tt/2qTHE73

Hypersensitivity reactions to gadolinium-based contrast agents.

Purpose of review: Gadolinium-based contrast agents (GBCAs) have been utilized since the late 1980s to enhance the diagnostic value of MRI studies. They are known to have excellent safety profile and serious adverse reactions are uncommon despite widespread global use. However, immediate hypersensitivity reactions are well described in the literature, with urticaria the most common manifestation. Anaphylaxis can occur, though fatality is extremely rare. This review explores the incidence of GBCA-related hypersensitivity reactions and highlights potential risk factors. Recent findings: Emerging evidence suggests that at least some immediate hypersensitivity reactions are IgE-mediated. Skin testing may be informative in confirmation of causality and revealing cross-reactivity patterns. Summary: GBCA hypersensitivity is infrequent but can be serious. Familiarity with management of acute hypersensitivity reactions may be lifesaving. Appropriate use of diagnostic testing can be used to guide future management of patients who have suffered from such reactions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rO7zwM

Alternative treatments for chronic spontaneous urticaria beyond the guideline algorithm.

Purpose of review: The international EAACI/GA2LEN/EDF/WAO guideline suggests a stepwise approach for the therapeutic management of chronic spontaneous urticaria (CSU), outlined in an algorithm. The aim of this article is to summarize and review the evidence available on alternative treatment options for CSU outside of this algorithm. Recent findings: Although CSU is a common disease, there are a limited number of high-quality studies, and only antihistamines and omalizumab are licensed for its treatment. Most studies regarding alternative therapies for CSU show methodological limitations and a high risk of bias. For many therapies, only case reports and uncontrolled studies exist. Recent publications on alternative treatments for chronic urticaria/CSU include reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, injection of autologous whole blood or serum, and phototherapy. Summary: Numerous treatments beyond the guideline algorithm have been evaluated in patients with refractory CSU. The global level of evidence to support their efficacy in CSU is low or very low. Further research is needed to assess the efficacy and safety of alternative therapies of CSU to manage adequately those patients who do not respond to the treatments included in the algorithm. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rRx0Ni

Non-IMF mandibular fracture reduction techniques: A review of the literature

Intermaxillary fixation (IMF) techniques are commonly used in mandibular fracture treatment to reduce bone fragments and re-establish normal occlusion. However, non-IMF reduction techniques such as repositioning forceps may be preferable due to their quick yet adequate reduction. The purpose of this paper is to assess which non-IMF reduction techniques and reduction forceps are available for fracture reduction in the mandible.

http://ift.tt/2qTjCuR

Hypersensitivity reactions to gadolinium-based contrast agents.

Purpose of review: Gadolinium-based contrast agents (GBCAs) have been utilized since the late 1980s to enhance the diagnostic value of MRI studies. They are known to have excellent safety profile and serious adverse reactions are uncommon despite widespread global use. However, immediate hypersensitivity reactions are well described in the literature, with urticaria the most common manifestation. Anaphylaxis can occur, though fatality is extremely rare. This review explores the incidence of GBCA-related hypersensitivity reactions and highlights potential risk factors. Recent findings: Emerging evidence suggests that at least some immediate hypersensitivity reactions are IgE-mediated. Skin testing may be informative in confirmation of causality and revealing cross-reactivity patterns. Summary: GBCA hypersensitivity is infrequent but can be serious. Familiarity with management of acute hypersensitivity reactions may be lifesaving. Appropriate use of diagnostic testing can be used to guide future management of patients who have suffered from such reactions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rO7zwM

Alternative treatments for chronic spontaneous urticaria beyond the guideline algorithm.

Purpose of review: The international EAACI/GA2LEN/EDF/WAO guideline suggests a stepwise approach for the therapeutic management of chronic spontaneous urticaria (CSU), outlined in an algorithm. The aim of this article is to summarize and review the evidence available on alternative treatment options for CSU outside of this algorithm. Recent findings: Although CSU is a common disease, there are a limited number of high-quality studies, and only antihistamines and omalizumab are licensed for its treatment. Most studies regarding alternative therapies for CSU show methodological limitations and a high risk of bias. For many therapies, only case reports and uncontrolled studies exist. Recent publications on alternative treatments for chronic urticaria/CSU include reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, injection of autologous whole blood or serum, and phototherapy. Summary: Numerous treatments beyond the guideline algorithm have been evaluated in patients with refractory CSU. The global level of evidence to support their efficacy in CSU is low or very low. Further research is needed to assess the efficacy and safety of alternative therapies of CSU to manage adequately those patients who do not respond to the treatments included in the algorithm. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rRx0Ni

Surgical orthodontics.

Purpose of review: The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Recent findings: Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. Summary: A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2qTf73A

Self-reported oral health and xerostomia in adult celiac disease patients versus a comparison group

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Publication date: Available online 23 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Tom van Gils, Gerd Bouma, Hetty J. Bontkes, Chris J.J. Mulder, Henk S. Brand
ObjectivesThis study aimed to assess the impact of celiac disease (CD) on oral health and xerostomia.Study DesignMembers of the Dutch Celiac Society (n=5,522) were invited to complete an online questionnaire based on the Oral Health Impact Profile 14 (OHIP-14) and Xerostomia Inventory (XI). Acquaintances and partners of the CD respondents served as the comparison group. In total, data of 740 CD patients and 270 comparison participants were evaluated.ResultsThe median age of the responding CD patients (55 years) was similar to the median age in the comparison group (53 years). Oral health problems, including aphthous stomatitis, painful mouth, and gingival problems, were more frequently reported by CD patients. Mean OHIP-14 score (4.9 vs 2.6, p<0.001) and the mean XI score (22.2 vs 17.2, p<0.001) were higher in CD than in the comparison group. No significant effects of gender, age at CD diagnosis or time on a gluten-free diet in mean OHIP-14 and XI scores were observed.ConclusionsThis study showed that oral health problems are more commonly experienced in adult CD patients than in the comparison group. Collaboration between dentists and gastroenterologists is recommended to increase detection of undiagnosed CD.



http://ift.tt/2qhqFcK

World Thyroid Day Recognized Globally on May 25th

American Thyroid Association

World Thyroid Day

World Thyroid Day Recognized Globally
American Thyroid Association collaborates with International Thyroid Societies

May 25, 2017

On May 25th the American Thyroid Association (ATA) (www.thyroid.org), in cooperation with the European Thyroid Association (www.eurothyroid.com), will be making an extraordinary effort to promote its year-round goals —focus attention on that small butterfly-shaped gland at the base of the neck that causes approximately 20 million Americans to experience thyroid disease.   In addition to the millions who have some form of thyroid disease, it is estimated that more than 12 percent of the U.S. population will develop a thyroid condition during their lifetime.

The important goal of the ATA and our sister thyroid organizations is to get the word out about Thyroid! Perhaps the most stunning statistics are that up to 60 percent of those with thyroid disease are unaware of their condition and that women are five to eight times more likely than men to have thyroid problems.  Almost everyone knows someone affected by thyroid disease or thyroid cancer and the ATA is proud to promote international awareness on World Thyroid Day so that symptoms, diagnosis, and treatment of conditions are available around the globe.  If you or someone you know are experiencing thyroid symptoms, make an appointment to see a thyroid specialist – you can find one in your area (in the US and internationally) by using the ATA Physician Referral Tool and you can read up on the thyroid educational materials in the ATA Thyroid Information Library.

The ATA is the leading organization devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  Our mission assures that we communicate the importance of the thyroid gland, which produces hormones that influence every cell, tissue, and organ in the body. Thyroid hormones regulate the body's metabolism—the rate at which the body produces energy from nutrients and oxygen—and affects critical body functions, such as energy level and heart rate. Through its mission, the ATA supports the clinicians and researchers who are at the frontlines of thyroid treatments and research. We also work with the public, patients, and their families to educate and increase awareness of thyroid diseases.

ATA member of 29 years, Dr. Gregory Brent – Chair, Department of Medicine from the University of California-Los Angeles says that, "The ATA has been my professional home since my fellowship and it has been a privilege to serve with my many valued colleagues and with such a committed and talented staff. I am most grateful to my mentors, who have encouraged and guided me. The professional and personal growths I have experienced from my involvement with the ATA are immeasurable."

The ATA Patient Thyroid Information library is just a few clicks away on the ATA website – http://ift.tt/25XAFbU and we encourage you to check back regularly for updates and new materials.  We are also pleased to offer many of our brochures in Spanish – http://ift.tt/2q8V7uD and provide a translator on the website for most languages.  The ATA website provides easy-to-access, patient-friendly information on topics such as:

Hypothyroidism: One of the most common thyroid conditions that occurs when the thyroid gland does not produce enough thyroid hormone. Symptoms include fatigue, depression, forgetfulness, irregular menses and weight gain. Treatment of hypothyroidism is usually with a synthetic form of thyroid hormone called "levothyroxine." Hashimoto's Thyroiditis is an autoimmune disease affecting the thyroid is the most common cause of hypothyroidism in the US, affecting mostly women. Diagnosis is usually confirmed by symptoms suggesting thyroid underactivity, positive anti-thyroid antibodies, and small goiter (thyroid enlargement) on physical examination. Patients with an elevated blood level of TSH and/or goiter are treated with thyroxine (T4).

On the opposite side of the spectrum is Hyperthyroidism and this occurs when the thyroid gland produces too much thyroid hormone. Symptoms include irritability, nervousness, muscle weakness, unexplained weight loss, sleep disturbances, vision problems and eye irritation. One type of hyperthyroidism, Graves' disease, is an autoimmune disorder that is partly genetic.

In addition to these common thyroid conditions, we also know that Thyroid Cancer is the most rapidly increasing form of cancer in the United States. The American Cancer Society estimates 58,670 new cases of thyroid cancer will be diagnosed in 2017 resulting in approximately 2,000 deaths. When thyroid cancer is identified and treated early, the majority of patients can be completely cured.

Mary Catherine Petermann whose father was diagnosed with Anaplastic Thyroid Cancer in 2006 describes how the ATA impacted her search for help, "The ATA was a valuable resource for our family when my dad was diagnosed with Anaplastic Thyroid Cancer. When you are faced with a detrimental diagnosis where even a few days can make the difference in life or death, understanding your options quickly is critical. The ATA website offers a one-stop shop for patients and caregivers to find specialists, current clinical trials, general thyroid cancer information, and links to other patient support groups and information"  Mary Catherine's father was treated by ATA member physicians at Mayo Clinic and has clean scans as of October 2016.

For thyroid cancer, Endocrinologists can sometimes employ minimally invasive procedures to distinguish thyroid cancer from benign thyroid nodules, which are common in the population. The ATA produces management guidelines for thyroid diseases and thyroid cancer, which, are open to the public and can accessed on the ATA website here: http://ift.tt/2qTzJ9R

We invite and encourage you to take a moment on the 25th of May, World Thyroid Day, to help ATA continue to serve patients, families, and the physicians to treat them by making a donation on the ATA World Thyroid Day Donation Page:   http://ift.tt/2q8Rjt0

Your donation will help ATA continue the important work of education, research, and awareness on this most important disease.  No donation is too small and if you would like to make a recurring donation throughout the year, please visit this page: http://ift.tt/2q8GFCx and select frequency that is good for you.

Your interest and support help make a positive impact on the lives of so many who struggle with thyroid conditions and thyroid cancer every day and we thank you for joining us and helping carry-out the ATA mission!

###

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization for over 1,700 clinicians and researchers from 43 countries around the world, representing a broad diversity of medical disciplines. It also serves the public, patients and their family through education and awareness efforts

Celebrating its 94th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology, VideoEndocrinology and Clinical Thyroidology for the Public; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease.

More information about ATA is found at www.thyroid.org.

The post World Thyroid Day Recognized Globally on May 25th appeared first on American Thyroid Association.



http://ift.tt/2qTzmMt

Effect of in-situ application of Simvastatin gel in Surgical Management of Osseous defects in Chronic Periodontitis-A Randomized Clinical Trial

Publication date: Available online 23 May 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Rajeev Ranjan, Sudhir R. Patil, Veena H.R.
BackgroundThe present randomized control study was designed to investigate the effect of in situ application of 1.2mg Simvastatin (SV) gel in surgical management of Intrabony defect in chronic periodontitis patients.Methodology20 patients contributing 40 sites were categorized into two treatment groups: Open flap debridement plus 1.2mg SV gel (Group 1) and Open flap debridement plus Placebo gel (Group 2). Gingival index (GI), Plaque index (PI), Pocket depth (PD) and clinical attachment level (CAL) were recorded at baseline, 3 months, 6 months and 9 months. At baseline and at the end of 6 and 9 months Radiographic evaluation of Intrabony defect fill was done using Image j software.ResultsSignificant reduction of GI, PD and gain in CAL was observed at the end of 9 months in both group. Amount of bone fill and percentage of original defect fill in Group 1 was statistically highly significant than Group 2 at the end of 6 and 9 months.ConclusionHigher amount of decrease in GI and PD along with more amount of CAL gain was observed in treatment group than controlled group. Radiological assessment confirmed that significant intrabony defect fill and percentage fill of original defect in treatment group than controlled group.



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The association between microsatellite instability and lymph node count in colorectal cancer

Abstract

The number of lymph nodes retrieved from colorectal cancer (CRC) resection specimens is crucial for adequate diagnosis and therapy. Previous studies indicate that in addition to the extent of surgical resection and the quality of pathological lymph node examination, non-modifiable tumour parameters like microsatellite instability (MSI) are associated with higher lymph node count. In order to study the potential influence of MSI on lymph node count, we analysed a previously MSI-typed population of CRC patients (n = 1196) to determine the relationship between MSI and the frequency with which at least 12 lymph nodes were retrieved, as well as the mean and median number of retrieved lymph nodes. MSI was associated with an increased frequency of 12-node retrieval, as well as a higher mean and median lymph node count in the overall analysis (p 0.004 and 0.001 for 12-node retrieval and lymph node count, respectively). However, when the analysis was restricted to cancers of the proximal colon, the main location of microsatellite unstable tumours (84% in our study), no association between MSI and 12-node retrieval was found. Subcategorisation by UICC stage of proximally located cancers showed a statistically significant increase in the lymph node count only in microsatellite unstable stage I tumours (p 0.010). In conclusion, our data shows that previously reported associations between MSI and higher lymph node count are mainly a consequence of the increased incidence of microsatellite unstable cancer in the proximal colon. Our finding that MSI is related to a significantly higher mean lymph node count in proximal stage I cancers may indicate that the immunogenicity of this molecular tumour type induces earlier lymph node activation.



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Current insights in noise-induced hearing loss: a literature review of the underlying mechanism, pathophysiology, asymmetry, and management options

Abstract

Background

Noise-induced hearing loss is one of the most common forms of sensorineural hearing loss, is a major health problem, is largely preventable and is probably more widespread than revealed by conventional pure tone threshold testing. Noise-induced damage to the cochlea is traditionally considered to be associated with symmetrical mild to moderate hearing loss with associated tinnitus; however, there is a significant number of patients with asymmetrical thresholds and, depending on the exposure, severe to profound hearing loss as well.

Main body

Recent epidemiology and animal studies have provided further insight into the pathophysiology, clinical findings, social and economic impacts of noise-induced hearing loss. Furthermore, it is recently shown that acoustic trauma is associated with vestibular dysfunction, with associated dizziness that is not always measurable with current techniques. Deliberation of the prevalence, treatment and prevention of noise-induced hearing loss is important and timely. Currently, prevention and protection are the first lines of defence, although promising protective effects are emerging from multiple different pharmaceutical agents, such as steroids, antioxidants and neurotrophins.

Conclusion

This review provides a comprehensive update on the pathophysiology, investigations, prevalence of asymmetry, associated symptoms, and current strategies on the prevention and treatment of noise-induced hearing loss.



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Intranasal distribution and clearance of thermoreversible gel in an animal model

Background

Poloxamer 407 (P407) has been investigated for an intranasal drug delivery system. However, there is little known about the distribution and clearance of intranasally applied P407. The purpose of this study was to evaluate the distribution and clearance time of P407 in an animal model.

Methods

Five male pigs were administered the experimental solution (18% of P407 with 0.01% of fluorescein) and the control solution (normal saline with 0.01% of fluorescein) into their right and left nasal cavity, respectively. For quantitative analysis, endoscopic images of each nasal cavity were taken immediately and at 10, 20, 30, and 60 minutes after intranasal administration.

Results

The experimental group showed a significantly wider distribution of fluorescein than the control group at 10, 20, and 30 minutes. The experimental group also showed a significantly higher mean intensity of fluorescein than the control group at 10, 20, and 30 minutes. The mean intensity in the control group was significantly decreased during 30 minutes but the mean intensity in the experimental group was significantly decreased during 60 minutes.

Conclusion

A substantial amount of P407 remained in the nasal cavity for at least 30 minutes post-application.



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Acute impact of continuous positive airway pressure on nasal patency

Background

Continuous airflow in the upper airway can cause discomfort, leading to nasopharyngeal complaints. The aim of the present study is to evaluate the acute effects of continuous positive upper-airway pressure on nasal patency in awake normal subjects.

Methods

Twenty-seven adults (17 men; 10 women; age range, 18 to 43 years) were exposed to continuous airway pressure (20 cmH2O) in the nasal cavity, delivered by a continuous positive airway pressure (CPAP) device through a nasal mask for 2 hours. Visual analogue scale (VAS) of nasal obstruction, Nasal Obstruction Symptom Evaluation (NOSE) modified scale, acoustic rhinometry (AR), and peak nasal inspiratory flow (PF) were measured before and after the use of CPAP.

Results

There was an increase in nasal obstruction scores both on the VAS (p < 0.05) and on the NOSE scale (p < 0.05), as well as a reduction in nasal cavity volume on AR (p < 0.05) and a decline in PF (p < 0.05). Subjects were stratified into 2 groups: with and without symptoms of allergic rhinitis. Nasal parameters were significantly worse in the rhinitis group, with higher nasal obstruction scores on the VAS (p = 0.001) and NOSE scale (p < 0.001) and decreased PF (p < 0.001).

Conclusion

Acute exposure to positive pressure via CPAP is associated with subjective and objective reductions in nasal patency. In individuals with allergic nasal symptoms, deterioration is even more severe than in patients without these symptoms.



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Current insights in noise-induced hearing loss: a literature review of the underlying mechanism, pathophysiology, asymmetry, and management options

Noise-induced hearing loss is one of the most common forms of sensorineural hearing loss, is a major health problem, is largely preventable and is probably more widespread than revealed by conventional pure to...

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Reirradiation for Small Inoperable Head and Neck Tumors

Condition:   Head and Neck Cancer
Interventions:   Radiation: SBRT;   Radiation: IMRT/IMPT;   Behavioral: Questionnaires
Sponsor:   M.D. Anderson Cancer Center
Not yet recruiting - verified May 2017

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G-CSF Administration in IVF in a Preferable Preceptive Endometrium Score

Condition:   Women Infertility
Interventions:   Procedure: Endometrial scratch;   Drug: G-CSF administration;   Drug: Saline Solution
Sponsors:   Istishari Arab Hospital;   Salem Abu Khyzaran;   Nizam Najeeb
Not yet recruiting - verified May 2017

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PET/MRI in Oropharyngeal Squamous Cell Carcinoma Evaluation

Condition:   Head and Neck Cancer
Intervention:   Diagnostic Test: PET/MRI for evaluation
Sponsors:   Chang Gung Memorial Hospital;   Ministry of Science and Technology, Taiwan
Recruiting - verified April 2017

http://ift.tt/2qS8PRK

Efficacy of photobiomodulation therapy on masseter thickness and oral health-related quality of life in children with spastic cerebral palsy

Abstract

The study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) on bilateral masseter muscle thickness and amplitude of mouth opening in children with spastic cerebral palsy (CP), and the impact on their oral health-related quality of life (OHRQOL). Three groups were included: experimental CP group (EG: n = 26 with oral complaints), positive control CP group (PCG: n = 26 without complaints), and negative control group (NCG: n = 26 without CP). In the EG, the masseter muscles on both sides were irradiated with an infrared low-level Ga-Al-As laser (λ = 808 ± 3 nm, 120 mW) using a 3 J/cm2 energy dose per site, with a 20 s exposure time per site (spot area: 4 mm2; irradiance: 3 W/cm2; energy delivery per point: 2.4 J) six times over six consecutive weeks. Masseter thickness, assessed through ultrasonography, and the amplitude of mouth opening were measured in the EG before and after six applications of PBMT and once in the PCG and NCG. The Parental-Caregiver Perception Questionnaire (P-CPQ) was used to evaluate OHRQOL. ANOVA, chi-square, t tests, and multilevel linear regression were used for statistical analysis. In the EG, the study results revealed average increments of 0.77 (0.08) millimeter in masseter thickness (P < 0.05) and 7.39 (0.58) millimeter for mouth opening (P < 0.05) and reduction in all P-CPQ domains (P < 0.001), except for social well-being. The six applications of PBMT increased masseter thickness and mouth opening amplitude and reduced the impact of spastic CP on OHRQOL.



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Risk factors for lymph node metastases of facial cutaneous squamous cell carcinoma

Publication date: Available online 22 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Katharina Obermeier, Matthias Tröltzsch, Michael Ehrenfeld, Wenko Smolka
PurposeDetermining the risk factors for lymph node metastases of facial cutaneous squamous cell carcinoma and identifying their value for predicting nodal spread.Materials and MethodsData on 99 patients were examined retrospectively. Conditions such as tumor staging, tumor thickness, location, histological grading, R1-resection, local recurrence, lymph node metastases, and neurovascular and lymphovascular invasion were evaluated. Statistical analysis was performed using a logistic regression analysis and Fisher's test.ResultsLogistic regression analysis indicates that poor differentiation, R1-resection, and periorbital location are high risk factors for nodal spread in facial cutaneous squamous cell carcinoma.ConclusionPatients who show poorly differentiated facial cutaneous squamous cell carcinoma and/or have had previous R1-resection might benefit from treatment of regional lymph nodes.



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Accuracy of measurements used to quantify cranial asymmetry in deformational plagiocephaly

Publication date: Available online 22 May 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Henri Aarnivala, Ville Vuollo, Tuomo Heikkinen, Virpi Harila, Lasse Holmström, Pertti Pirttiniemi, A. Marita Valkama
ObjectiveVarious measurements are used to quantify cranial asymmetry in deformational plagiocephaly (DP), but studies validating cut-off values and comparing the accuracy of such measurements are lacking. In this study, we compared the accuracy of four different measurements in classifying children with and without DP diagnosed by visual assessment, and sought to determine their optimal cut-off values.Study DesignTwo experts rated 407 3D craniofacial images of children aged between 3 and 36 months old using the Argenta classification. We then measured the following asymmetry-related variables from the images: Oblique Cranial Length Ratio (OCLR), Diagonal Difference (DD), Posterior Cranial Asymmetry Index (PCAI), and weighted Asymmetry Score (wAS). We created receiver operating characteristic curves to evaluate the accuracy of these variables.ResultsAll variables performed well, but OCLR consistently provided the best discrimination in terms of area under the curve values. Subject's age had no clear effect on the cut-off values for OCLR, PCAI, and wAS; however, the cut-off for DD increased monotonically with age. When subjects with discrepant expert ratings were excluded, the optimal cut-off values for DP (Argenta class ≥ 1) across all age-groups were 104.0% for OCLR (83% sensitivity, 97% specificity), 10.5% for PCAI (90% sensitivity, 90% specificity), and 24.5 for wAS (88% sensitivity, 90% specificity).ConclusionWe recommend using OCLR as the primary measurement, although PCAI and wAS may also be useful in monitoring cranial asymmetry. The threshold of relative asymmetry required for a deformation to appear clinically significant is not affected by the child's age, and DD has no additional utility in monitoring DP compared to using only OCLR.



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Management of Kounis syndrome: two case reports

Kounis syndrome corresponds to the occurrence of myocardial injury following an allergic insult. This syndrome is infrequent, and is not well known. In consequence, it is usually misdiagnosed leading to inappr...

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Giant orf tumor in an immunocompromised patient

Abstract

Herein, we report the efficacy and the safety of open-spray cryotherapy in an immunocompromised woman presenting with tumor-like orf lesion. A 58-year-old woman was referred with a 4-month history of an undiagnosed, painful, ulcerated, tumor-like lesion on the last phalanx of the fifth digit of her left hand. Six months earlier, the woman had received a cadaveric kidney transplant for an indication of focal segmental glomerulosclerosis.

This article is protected by copyright. All rights reserved.



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A novel nonframeshift deletion in MVK gene responsible for disseminated superficial actinic porokeratosis in one Chinese family

Abstract

Disseminated superficial actinic porokeratosis (DSAP), a genodermatosis transmitted as an autosomal dominant trait featuring disorder of keratinization, is characterized clinically by annular plaques with an atropic center and hyperkeratotic edges.1-4 Recently, Zhang et al. 2 reported MVK mutations in 33% familiar and 16% sporadic patients with DSAP by exome sequencing. Here, we report a single novel mutation of MVK, p.Cys161_Arg176del, in a Chinese family suffering from DSAP.

This article is protected by copyright. All rights reserved.



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Central nervous system involvement of primary cutaneous diffuse large B-cell lymphoma, leg type: 13 cases

Abstract

Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) is an aggressive primary cutaneous B-cell lymphoma affecting older people.1 Rituximab (RTX) combined with polychemotherapy (RTX-PCT) has improved survival but relapses are frequent.2 Central nervous system (CNS) involvement is rare and poorly described.

This article is protected by copyright. All rights reserved.



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The cutaneous disease of Saint Ubald of Gubbio (1084–1160)

Abstract

Ubald was a Catholic Church Saint (1084 – 1160), born in Gubbio (Umbria, Italy) and died after two years of painful illness; his mummy is now guarded in a glass sarcophagus at Sant'Ubald Cathedral in Gubbio. Informations about Ubald are derived by his two main biographers: Iordanus (Giordano) of Città di Castello1 and Theobaldus (Teobaldo), his successor in the episcopal seat2.

This article is protected by copyright. All rights reserved.



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Prolonged denervation induces remodeling of nasal mucosa in rat model of posterior nasal neurectomy

Background

The posterior nasal nerve is the dominant source of the parasympathetic, sympathetic, and sensory fibers that innervate the nasal respiratory mucosa. Therefore, a posterior nasal neurectomy (PNN) induces denervation of the nasal mucosa and relieves the nasal symptoms of intractable rhinitis. PNN depletes nerve fibers, choline acetyltransferase, and neuropeptides in nasal respiratory mucosa, and reduces nasal secretion. However, the histological and symptomatic changes over an extended period after PNN remain unknown.

Methods

Using a rat model of PNN via the transorbital approach, we investigated chronological changes of nasal morphology, innervation, and secretion over a 48-week postoperative period after PNN.

Results

The respiratory nasal mucosa exhibited squamous metaplasia, lymphocyte and plasma cell infiltration, basement membrane thickening, loss of cilia, and hyperplasia of the mucus gland in thickened epithelium with increased connective tissue from 24 weeks after PNN. These changes resemble the characteristics of remodeling in chronic rhinosinusitis. DNA microarray and quantitative polymerase chain reaction analysis revealed that mucin 5ac, interleukin 13, and brain-derived neurotrophic factor messenger RNA (mRNA) were upregulated in PNN-treated mucosa compared to untreated mucosa. During this period, nerve fibers including sensory, sympathetic, and parasympathetic fibers gradually reinnervated the mucosa from 12 weeks after PNN. However, nasal secretion was decreased even at 48 weeks after PNN probably due to the prolonged absence of choline acetyltransferase.

Conclusion

Prolonged denervation induces remodeling of the nasal mucosa. Although the depleted nerves were partially reinnervated a few months after PNN, nasal secretion was still suppressed, partly due to a sustained deficiency of acetylcholine synthesis.



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Effects of ophthalmologic solutions on sinonasal ciliated epithelium

Background

Off-label use of topical ophthalmologic formulations for treatment of rhinologic disease is cited in recent literature and is anecdotally prevalent among practicing otolaryngologists. Steroids, antibiotics, and other drugs designed for ocular use have subjective clinical efficacy in the nose and sinuses, but their specific effects on the ciliated epithelium are less well defined. This study examines 9 commercially available ophthalmologic drug formulations for effects on ciliary motility in sinonasal cultures, in an effort to characterize their utility as topical therapies for sinonasal diseases.

Methods

Ophthalmologic solutions were tested on human sinonasal cultures grown at an air-liquid interface. Baseline ciliary beat frequency (CBF) was recorded and compared with CBF changes in the 20 minutes after drug addition. Substances were categorized by degree of ciliostimulation or cilioinhibition.

Results

All ophthalmologic solutions tested had only moderate effects on CBF during the 20-minute experimental period, with no solutions causing overt ciliostasis. Azithromycin, neomycin, and olopatadine were slightly ciliostimulatory, whereas levofloxacin, tobramycin, dexamethasone, azelastine, and prednisolone acetate were cilioinhibitory. Ciprofloxacin elicited moderate cilioinhibition that progressed to ciliostimulation.

Conclusion

All solutions tested appear to have moderate effects on ciliated cell surfaces for a period of time typical of mucociliary clearance (10 to 20 minutes). Both active drugs and excipients can play a role in ciliary modulation, and specific formulations can show unique or unexpected properties. Any other individual ophthalmologic solutions to be used in a nasal drug delivery system should be tested in this manner to evaluate potential ciliary effects before clinical use.



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Development of bullous pemphigoid during secukinumab treatment for psoriasis



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Secukinumab improves psoriasis symptoms in patients with inadequate response to cyclosporine A: A prospective study to evaluate direct switch

Abstract

There are limited data on the safety and efficacy of switching to secukinumab from cyclosporine A (CyA) in patients with psoriasis. The purpose of the present study was to assess the efficacy and safety of secukinumab for 16 weeks after direct switching from CyA in patients with moderate-to-severe psoriasis. In this multicenter, open-label, phase IV study, 34 patients with moderate-to-severe psoriasis and inadequate response to CyA received secukinumab 300 mg s.c. at baseline and weeks 1, 2, 3, 4, 8 and 12. The primary end-point was ≥75% improvement from baseline in Psoriasis Area and Severity Index score (PASI 75) at week 16. The efficacy of secukinumab treatment was evaluated up to week 16, and adverse events (AE) were monitored during the study. The primary end-point of the PASI 75 response at week 16 was achieved by 82.4% (n = 28) of patients receiving secukinumab. Early improvements were observed with secukinumab, with PASI 50 response of 41.2% at week 2 and PASI 75 response of 44.1% at week 4. AE were observed in 70.6% (n = 24) of patients, and there were no serious AE or deaths reported in the entire study period. Secukinumab showed a favorable safety profile consistent with previous data with no new or unexpected safety signals. The results of the present study show that secukinumab is effective in patients with psoriasis enabling a smooth and safe direct switch from CyA to biological therapy.



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Primary signet-ring cell/histiocytoid carcinoma of the eyelid expressing androgen receptors and treated with bicalutamide



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Breast angiosarcoma without radiation history, putatively associated with subclinical lymphedema: A case report and review of the Japanese literature



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Clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia: The relation between the disease activity and the serum interleukin-6 level

Abstract

A 67-year-old woman exhibited chilblain-like erythema on the bilateral auricles, erythema with hyperkeratosis on the sides of fingers and the bilateral elbows, and erythema on the extensor/flexor sides of the finger joints and the iliac regions. Fine crackles were audible on the dorsal side of the bilateral lower lung regions. We diagnosed clinically amyopathic dermatomyositis accompanied by rapidly progressive interstitial pneumonia. While we initiated immunosuppressive therapy, the respiratory failure showed no responses. We performed endotoxin adsorption therapy using polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP). After the first PMX-DHP session, the respiratory condition was slightly improved but it soon deteriorated. At the second PMX-DHP session, subcutaneous and mediastinal emphysema was noted. The patient died, showing no improvement in the respiratory condition. We measured the levels of serum interleukin (IL)-6, tumor necrosis factor (TNF)-α and IL-10 before and after PMX-DHP and compared them with previously reported levels. The levels of TNF-α and IL-10 showed no or slight changes, but those of IL-6 at the beginning of the treatment were higher compared with previous reports. After the first PMX-DHP, the IL-6 level decreased with slight improvement in respiratory condition. However, after the second PMX-DHP, it increased markedly with exacerbation of the respiratory failure. The serum IL-6 level is considered to be effective for the evaluation of the disease activity and prognosis under the treatment by PMX-DHP.



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Solar urticaria with an augmentation spectrum in a child



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Post-scabetic nodules



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Oral health status in adult patients with newly diagnosed acute leukemia

Abstract

Background

The aim of this cross-sectional study was to evaluate the oral health of adult patients with newly diagnosed acute leukemia.

Methods

Patients with initially diagnosed acute myeloid (AML) or lymphocytic (ALL) leukemia and a matched healthy control (HC) group were included. The oral investigation comprised inspection of the oral mucosa; the decayed (D), missing (M), and filled (F) teeth (DMF-T) index; and a detailed periodontal status. Subgingival biofilm samples were analyzed (polymerase chain reaction) for the presence of selected potentially periodontal pathogenic bacteria. Statistical analysis was performed using Fisher's exact test, chi-squared test, and Mann-Whitney U test (significance level α = 5%).

Results

Thirty-nine patients with leukemia (AML 26, ALL 13) and 38 HCs were included. Oral mucosal findings were present in 62% of L compared to 0% of HC patients, whereby gingival hyperplasia was the most detected finding. Furthermore, a higher caries prevalence in leukemia patients was shown (D value 3.64 ± 3.98 vs. 0.72 ± 1.72, p < 0.01). The periodontal parameters were poorer in leukemia patients. No substantial differences in microbiological findings of selected bacteria were detected within L group and between L and HC patients.

Conclusion

The high prevalence of oral diseases supports the demand of an early and consequent dental treatment of leukemia patients, especially considering subsequent therapy.



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Antiphospholipid Syndrome: Multiple Manifestations in a Single Patient—A High Suspicion Is Still Needed

Antiphospholipid Syndrome (APS) is an autoimmune disorder with clinical and laboratory features of vascular thrombosis, pregnancy loss, and persistent antiphospholipid antibodies (aPLs). The pathophysiology is thought to involve the activation of endothelial cells, monocytes, platelets, and complement by aPLs. Disease can range from asymptomatic to rapidly fatal catastrophic APS. We present a case of a 34-year-old male referred for pancytopenia and splenomegaly. On examination, he had decreased sensation and 4/5 power in the left upper extremity. A lacy, purplish rash was noted on the trunk and upper extremity. MRI of brain showed acute/subacute lacunar infarctions. Laboratory studies revealed an elevated lactate dehydrogenase level, bilirubin and ferritin, decreased haptoglobin, and positive Coombs test. Antinuclear antibody test was negative and antiphospholipid antibody panel revealed positivity for anti-cardiolipin IgG and IgM, antiphosphatidylserine IgG, and anti-β2-glycoprotein IgG. The patient was diagnosed with primary APS. Pancytopenia is relatively rare in primary APS and is more often seen in secondary APS. Our patient demonstrated involvement of multiple organ systems as well as livedo reticularis and autoimmune-related findings such as Raynaud phenomenon and Coombs positive hemolytic anemia. We discuss the various clinical and laboratory findings in patients with APS that aid in diagnosis, as well as important management considerations.

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A Novel Surgical Technique for Fixation of Recurrent Acromioclavicular Dislocations: AC Dog Bone Technique in Combination with Autogenous Semitendinosus Tendon Graft

Various surgical techniques have been described for the fixation of acromioclavicular (AC) dislocations. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. We report a case of postoperative AC joint redislocation. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid ligament with the use of a free tendon graft in combination with a FiberTape was provided within a novel surgical technique. After 12 months, the patient was very satisfied with the functional outcome. The patient achieved excellent results in the Constant (98 points), SPADI (0 points), and QuickDASH score (0 points). The described technique results in an anatomic reconstruction of the AC joint. The nonrigid nature of the intervention seems to restore the normal arthrokinematics by reconstructing the coracoclavicular ligaments with an autograft which is then protected by the AC Dog Bone artificial ligaments during the healing period. The arthroscopic approach to the AC joint with minimal exposure reduces the risks and complications of the intervention. This is the first case in literature that utilizes the artificial dog bone ligament securing the autograft in an anatomic AC reconstruction.

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Benign atrophic papulosis (Köhlmeier-Degos disease): The wedge-shaped dermal necrosis can resolve with time

Abstract

Background

Atrophic papulosis is a rare thrombo-occlusive disease, characterized by the appearance of multiple atrophic porcelain-white skin papules, with a surrounding erythematous rim, which are histologically consisting of wedge-shaped necrosis of the dermis.

Objective

It consists of two variants: a) the benign atrophic papulosis (BAP) only involving the skin and b) the malignant atrophic papulosis (MAP) also involving several internal organs with a cumulative 5-year survival rate of approx. 55%. While the probability of only having a BAP at onset is approximately 70%, increasing to 97% after 7 years of monosymptomatic cutaneous course, no close long-term follow-up of the development of the skin lesions has been reported.

Methods

We present a precise visual documentation of the evolution of the disseminated skin lesions in a female patient with BAP spanning over two decades.

Results

A considerable improvement and/or clinical resolution of the majority of the lesions disputing the scarring character of the atrophic porcelain-white skin papules has been detected.

Conclusion

BAP not only exhibits an excellent prognosis but resolution of lesions can also occur after a considerable period of time.

This article is protected by copyright. All rights reserved.



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Pustular erythema multiforme major associated with atypical pneumonia

Abstract

A 52-year-old male patient presented to the hospital with severe difficulties swallowing, sore eyes and an asymptomatic skin rash. The patient was fully oriented, vital signs were normal. Two days before admission to the hospital, the referring physician had suspected an upper respiratory tract infection and had started treatment with oral cefuroxime while also prescribing ibuprofen for sore throat.

This article is protected by copyright. All rights reserved.



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The molluscum pendulum necklace sign in tuberous sclerosis complex: a case series.A pathognomonic finding?

Abstract

Molluscum pendulum (MP) are a very common finding in the general population. They can be a marker of abnormal glucose metabolism(1,2) or a classical sign of tuberous sclerosis complex (TSC) (3). Here we reported the occurrence of multiple MP located in the posterior neck with a peculiar arrangement in a series of patients with TSC.

This article is protected by copyright. All rights reserved.



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Acral Plexiform Palisaded Encapsulated Neuromas as the Initial Cutaneous Manifestation of Cowden Syndrome

Abstract

Cowden syndrome (CS) is an autosomal dominant genodermatosis associated with characteristic mucocutaneous findings of facial trichilemmomas, palmoplantar keratoses, sclerotic fibromas, and oral papillomas. Mucocutaneous neuromas have also been reported in association with CS. We describe a patient with CS whose sole cutaneous finding was palisaded encapsulated neuromas (PENs) with a plexiform growth pattern in an acral location. Along with previous reports, this case suggests that acral plexiform PENs may be an early, highly specific finding in CS and highlights the importance of screening these patients for PTEN mutation.



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Lichenoid Drug Eruption with Prominent Nail Changes Due to Leflunomide in a 12-Year-Old Child

Abstract

We present the case of a 12-year-old-girl who developed lichenoid dermatitis approximately 1 year after starting leflunomide for juvenile idiopathic arthritis. The eruption resolved promptly with discontinuation of the suspected culprit agent, supportive of a lichenoid drug eruption, but she subsequently developed markedly dystrophic nails with lichen planus–like features. A biopsy of her cutaneous findings at the time of initial presentation demonstrated lichenoid dermatitis, and a nail matrix biopsy was deferred given clinical correlation. Prominent nail changes in lichenoid drug eruptions, particularly in children, are rare but should be considered in children with new-onset nail dystrophy.



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A Novel VPS33B Mutation in a Patient with Arthrogryposis-Renal Dysfunction-Cholestasis Syndrome

Abstract

We report a case of arthrogryposis-renal dysfunction-cholestasis (ARC) syndrome in a girl with a novel VPS33B mutation. To our knowledge, this is the first reported case of ARC syndrome in the United States.



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Thrombocytopenia Associated with Localized Scleroderma: Report of Four Pediatric Cases and Review of the Literature

Abstract

We report on four children with localized scleroderma (morphea) and thrombocytopenia. All four had the en coup de sabre subtype of morphea and had varying degrees of thrombocytopenia (8 × 109/L to 120 × 109/L). None of them had major bleeding manifestations, and thrombocytopenia resolved with treatment of morphea. (One patient was also given an injection of anti-D immunoglobulin.) We propose that thrombocytopenia associated with localized scleroderma is usually benign and requires no specific therapy.



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Congenital Atrophic Plaque: Fibroblastic Connective Tissue Nevus

Abstract

Fibroblastic connective tissue nevus (FCTN) is a rare, benign, dermal mesenchymal hamartoma that affects children. We report a 15-year-old boy with a congenital FCTN and describe the clinical, dermatoscopic, and histopathologic features.



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Clinical, Microscopic and Ultrastructural Findings in a Case of Short Anagen Syndrome

Abstract

Short anagen syndrome is an uncommon and recently described disease characterized by many telogen hairs and short maximum hair length. We report here the case of a 3-year-old girl whose short, sparse, fine hair since birth was consistent with short anagen syndrome. X-ray microanalysis demonstrated normal composition of the main bioelements of her hairs.



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Metastatic Squamous Cell Carcinoma in a Patient with Disabling Pansclerotic Morphea of Childhood

Abstract

Disabling pansclerotic morphea of childhood (DPMC) is a rare disorder that confers a risk of developing ulcer-related squamous cell carcinoma (SCC). We describe a young man with long-standing DPMC and SCC with lung metastasis.



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I Do Not Like Green Eggs

Abstract

Shells of pinworm ova contain chitin, which stains bright green when exposed to chlorazol black E. The objective was to determine whether chlorazol black E could assist in identification of pinworm ova from skin scrapings. Skin scrapings were stained using chlorazol black E and pinworm ova were more easily recognized, staining a blue-green color.



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Practice Patterns of Dermatologists in the Pediatric Contact Dermatitis Registry

Abstract

Background/Objectives

U.S. adults and children are equally likely to have allergic contact dermatitis. Historically the narrow geographic location of data-reporting providers has quantitatively and qualitatively limited the pediatric contact dermatitis data. The Pediatric Contact Dermatitis Registry was used to evaluate self-identified pediatric patch test providers within the United States with regard to demographic characteristics, geographic location, and practice patterns.

Methods

A wide range of U.S. providers were invited to join the registry by completing a secure online 11-question registration survey.

Results

There were 252 respondents from 50 states and the District of Columbia; 28.6% were pediatric dermatologists and members of the Society for Pediatric Dermatology (SPD), and 38% were members of the American Contact Dermatitis Society. The cumulative range of pediatric patch-test evaluations performed each year was 1,726 to 4,613 children. SPD members had a significantly greater likelihood of performing a commercially available patch test (odds ratio 7.14 [95% confidence interval 5.11, 9.97], p < .001) than those who were not SPD members. SPD members also had significantly lower odds of performing North American Contact Dermatitis Group standard tests than nonmembers.

Conclusions

The frequency of patch test evaluations in children is significantly underreported. This study provides insight into the practice patterns of various providers who are patch testing children and makes recommendations for evidence-based modifications regarding these practices. Limitations of the study include survey responder selection bias and small sample size.



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Contents

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Publication date: May 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 3





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Editorial Board

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Publication date: May 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 3





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Prognostic models and nomograms for predicting survival of patients with maxillary sinus carcinomas

Background

Maxillary sinus carcinoma is an uncommon malignancy. Most reports on prognosis of this disease are from single institutions and include few patients. We used data from the United States National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program to construct models and nomograms for predicting outcomes of patients with maxillary sinus carcinomas.

Methods

We used records from 668 patients with primary maxillary sinus carcinomas reported to the SEER program from 2004 to 2013 to build nomograms based on stratified multivariable Cox proportional hazard models for predicting 5-year overall survival (OS) and cause-specific survival (CSS). Model building was internally validated with the bootstrap approach.

Results

Five-year survival was 39.7% (95% confidence interval [CI], 35.5% to 44.5%) and 46.8% (42.3% to 51.8%) for OS and CSS, respectively. The final Cox model included the variables of age at diagnosis, tumor size, histologic type, TNM stage, and surgery. Radiotherapy was a stratification factor in the models. The models demonstrated good accuracy for predicting survival with a bootstrap-corrected Somers Dxy of 0.44 for both OS and CSS models. Calibration curves indicated acceptable model calibration.

Conclusion

We developed tools for predicting prognosis that incorporate TNM stage and other readily available variables for patients with maxillary sinus carcinomas. The model performance was validated as good. These models can help clinicians to offer improved patient counseling in terms of clinical outcomes and make optimal treatment plans.



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Chronic sinonasal tract inflammation as a precursor to nasopharyngeal carcinoma and sinonasal malignancy in the United States

Background

Chronic inflammatory states have been linked to the development of malignancy. Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) have been associated with nasopharyngeal carcinoma (NPC) in population-based studies in Asia. A similar association with NPC and paranasal sinus malignancy (PSM) has not been defined in a North American population. Our purpose was to investigate the impact of CRS and AR on the risk of NPC and PSM.

Methods

The Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database was queried as a case-control study of adults ≥65 years of age. The study cohort included 2009 patients diagnosed with NPC and/or PSM diagnosed between 2003 and 2011, and 2009 propensity-score-matched controls selected from a 5% random sample of Medicare beneficiaries without cancer. CRS and AR were examined as exposures. Multivariable unconditional logistic regression was employed.

Results

Overall, NPC and PSM patients were more likely to have previous CRS diagnosis than the controls (9.2% vs 3.0% and 11.1% vs 2.7%, respectively). CRS was associated with greater odds of developing NPC (odds ratio [OR], 3.51; 95% confidence interval [CI], 2.12-5.79) and PSM (OR, 5.30; 95% CI, 3.55-7.92). AR was associated with greater odds of developing NPC (OR, 4.23; 95% CI, 2.96 to 6.06) and PSM (OR, 3.35; 95% CI, 2.49-4.49). The number needed to harm in the exposed population was 311.

Conclusions

CRS and AR are associated with the presence of NPC and PSM in the elderly population of United States. This epidemiologic association will need to be examined for causative pathophysiologic mechanisms and utility in clinical diagnosis.



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The effect of allergen immunotherapy in the onset of new sensitizations: a meta-analysis

Background

Although the preventive efficacy of allergen immunotherapy (AIT) in the onset of new allergen sensitizations has been asserted by many reviews, position papers, and consensus conferences, the evidence available is from only 3 studies. The objective of this work was a systematic review to evaluate the preventive efficacy of AIT in the onset of new allergen sensitizations. The end-point was the risk difference (RD) in the onset of new allergen sensitizations between patients treated with AIT and pharmacotherapy.

Methods

Computerized bibliographic searches of MEDLINE, EMBASE, and the Cochrane Library (until November 30th, 2016) were done. Random-effects and fixed-effects model meta-analyses were performed. Randomized controlled trials or observational studies comparing children treated with AIT with house dust mite (HDM) to subjects who did not receive AIT, with a long-term observation period (at least 3 years including treatment and follow-up) have been included.

Results

Eight studies totaling 721 children (390 treated with AIT and 331 with pharmacotherapy) met the inclusion criteria. The risk of bias was high. Low evidence supports the conclusion that AIT prevents the onset of new allergen sensitizations, with 3 of 8 studies reporting a reduction in the onset of new sensitizations in patients treated with AIT vs pharmacotherapy. Our meta-analysis found no difference between AIT and pharmacotherapy, with high heterogeneity (RD, −0.10; 95% confidence interval [CI], −0.31 to 0.11; p = 0.32; I2 = 91.4%).

Conclusion

The data of this systematic review do not support a preventive effect in the onset of new allergen sensitizations, in children treated with AIT in comparison with those treated with pharmacotherapy.



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Denatonium-induced sinonasal bacterial killing may play a role in chronic rhinosinusitis outcomes

Background

Sinonasal bitter taste receptors (T2Rs) contribute to upper airway innate immunity and correlate with chronic rhinosinusitis (CRS) clinical outcomes. A subset of T2Rs expressed on sinonasal solitary chemosensory cells (SCCs) are activated by denatonium, resulting in a calcium-mediated secretion of bactericidal antimicrobial peptides (AMPs) in neighboring ciliated epithelial cells. We hypothesized that there is patient variability in the amount of bacterial killing induced by different concentrations of denatonium and that the differences correlate with CRS clinical outcomes.

Methods

Bacterial growth inhibition was quantified after mixing bacteria with airway surface liquid (ASL) collected from denatonium-stimulated sinonasal air-liquid interface (ALI) cultures. Patient ASL bacterial killing at 0.1 mM denatonium and baseline characteristics and sinus surgery outcomes were compared between these populations.

Results

There is variability in the degree of denatonium-induced bacterial killing between patients. In CRS with nasal polyps (CRSwNP), patients with increased bacterial killing after stimulation with low levels of denatonium undergo significantly more functional endoscopic sinus surgeries (FESSs) (p = 0.037) and have worse 6-month post-FESS 22-item Sino-Nasal Outcome Test (SNOT-22) scores (p = 0.012).

Conclusion

Bacterial killing after stimulation with low levels of denatonium correlates with number of prior FESS and postoperative SNOT-22 scores in CRSwNP. Some symptoms of CRS in patients with hyperresponsiveness to low levels of denatonium may be due to increased airway immune activity or inherent disease severity.



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Safety and Perioperative Adverse Events in Pediatric Endoscopic Sinus Surgery: An ACS-NSQIP-P Analysis

Introduction

This study describes safety outcomes of pediatric endoscopic sinus surgery (ESS) to identify risk factors for 30-day postoperative adverse events using the National Surgical Quality Improvement Program–Pediatric (NSQIP-P) database.

Methods

We performed a retrospective cohort study involving patients in the 2012–2015 NSQIP-P database who underwent ESS. Predictors included demographics, comorbidities and surgical acuity. Outcomes included 30-day complications, reoperations, and readmissions.

Results

Among 2,061 ESS cases identified, 1,829 (88.7%) were elective and 232 (11.3%) were urgent/emergent. There were 92 (4.5%) readmissions, 54 (2.6%) unplanned reoperations, and 61 (3.0%) complications. On multivariate analysis, readmission was associated with urgent/emergent procedures (OR 2.31, CI 1.36-3.93, p<0.01) and history of bleeding disorder (OR 2.24, CI 1.12-4.44, p = 0.02), reoperation was associated with urgent/emergent procedures (OR 5.78, CI 3.24-10.34, p<0.01), and complications were associated with urgent/emergent procedures (OR 3.81, CI 2.13-6.82, p<0.01) and history of bleeding disorder (OR 5.30, CI 2.74-10.20, p<0.01). Bleeding requiring transfusion was associated with urgent/emergent procedures (OR 9.61, CI 2.90-31.80, p<0.01), history of bleeding disorder (OR 14.16, CI 4.41-45.45, p<0.01), and age <3 years (OR 3.92, CI 0.99-15.61, p = 0.05). Black children were significantly more likely to undergo urgent/emergent surgery than white children (19.7% vs. 9.6%, p<0.01).

Conclusions

This multi-institutional study confirms that while pediatric ESS is largely safe, urgent/emergent procedures carry the greatest risk of postoperative adverse events, and black children are significantly more likely to undergo higher acuity surgery than white children. Regardless of procedure acuity, young age and bleeding disorder are associated with higher risk of 30-day adverse events.



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Computational fluid dynamics evaluation of posterior septectomy as a viable treatment option for large septal perforations

Background

Numerous surgical techniques exist to treat nasal septal perforation (NSP). The surgical closure of large NSPs (>2 cm) is still challenging. Posterior septectomy has been reported as a simple alternative to treat large NSP, yet its mechanisms for symptom relief are not clear, and if failed, its consequence cannot be easily reversed.

Methods

Ten NSP patients were recruited: 5 underwent posterior septectomy and 5 underwent conventional flap or button repair. Computational fluid dynamics (CFD) simulated the nasal aerodynamics based on computed tomography (CT) scans. All patients had preoperative CT; however, only 4 had postoperative CT: 2 underwent posterior septectomy and the other 2 underwent flap repair. We examined surgical outcomes and the nasal airflow features among the 2 treatment options.

Results

Both groups of patients had good outcomes based on chart review. Patients undergoing septectomy had significantly larger perforation size (2.32 ± 0.87 vs 1.21 ± 0.60 cm), higher flow rate across the perforation (47.8 ± 28.6 vs 18.3 ± 12.2 mL/second), and higher wall shear stress (WSS) along the posterior perforation margin (1.39 ± 0.52 vs 1.15 ± 0.58 Pa). The posterior WSS significantly correlated with crossover flow velocity (r = 0.77, p = 0.009) and was reduced by almost 67% postseptectomy, and by 29% postrepair.

Conclusion

This is the first CFD analysis on an NSP patient cohort. NSP resulted in flow disturbance and increased WSS that potentially led to symptomatology. The removal of high stress points along the posterior margin may explain why posterior septectomy can be an effective treatment option. Aerodynamic abnormalities, in addition to perforation size and location, could serve as basis for future treatment decisions.



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Bottom of an iceberg: undiagnosed aortic aneurysm masquerading as vocal cord palsy

http://otorhinolaryngology-crete.blogspot.com/2017/05/undiagnosed-aortic-aneurysm.html
 από Rao, V. U. S., Chatterjee, S., Swamy, S. S. στο BMJ Case Reports Last 6 Issues Μετάφραση άρθρου Description A previously healthy woman aged 60 years was referred to a tertiary referral cancer centre with change of voice for 1 week suspecting neoplastic aetiology on account of her tobacco chewing habit of more than 20 years. No history of voice abuse, fever or cough was there preceding the onset of the change of voice. She did not have any previous history of hospitalisation or diagnosed comorbidities. On clinical examination, her pulse rate was 82 bpm; blood pressure was 130/90 mm Hg and respiratory rate was 12/min.  Video laryngoscopy examination revealed left vocal cord palsy with no obvious lesion. A whole-body F18 FDG PET–CT scan revealed the presence of 6.6x4.8x6.7 cm lobulated sacullar aneurysm arising from the aortic arch between the origins of the left common carotid and subclavian arteries (figures 1 and 2). The likely mycotic aneurysm caused significant surrounding metabolically active inflammatory changes (figure 3).

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Single-port approach to endoscopic pericranial scalp flap for anterior cranial fossa closure



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Comparative effect of the sites of anterior cervical pressure on the geometry of the upper esophageal sphincter high-pressure zone

Objectives/Hypothesis

External cricoid pressure is increasingly used to augment the upper esophageal sphincter (UES). Our objective was to determine the effect of 1) pressures applied to cricoid, supracricoid, and subcricoid regions on the length and amplitude of the UES high-pressure zone (UESHPZ), and 2) the external cricoid pressure on lower esophageal sphincter (LES) tone.

Study Design

Case-control study.

Methods

We studied 11 patients with supraesophageal reflux (mean age 58 ± 12 years) and 10 healthy volunteers (mean age 47 ± 19 years). We tested 20, 30, and 40 mm Hg pressures to cricoid, 1 cm proximal and 1 cm distal to the cricoid. In an additional 15 healthy volunteers (mean age 46 ± 23 years), we studied the effect of external cricoid pressure on LES tone. UES and LES pressures were determined using high-resolution manometry.

Results

There was significant increase of UESHPZ length with application of pressure at all sites. The increase of UESHPZ length was relatively symmetric, more orad, and more caudad when the pressure was applied at the cricoid, supracricoid, and subcricoid levels, respectively. The magnitude of pressure increase was greatest at the middle and orad part of the UESHPZ when the pressure was applied at the cricoid and supracricoid levels, respectively. The corresponding magnitude of increase in the caudad part of the UESHPZ was not observed with pressure at the subcricoid level. There was no change of the LES pressure with application of cricoid pressure.

Conclusions

The effect of external pressure on the UESHPZ is site dependent. Subcricoid pressure has the least effect on UESHPZ. External cricoid pressure at 20 to 40 mm Hg has no effect on the LES pressure.

Level of Evidence

3b. Laryngoscope, 2017



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The Birkett Lecture: Avoiding the unhappy patient: The ABCs of rapport building



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Central voice production and pathophysiology of spasmodic dysphonia

Objective

Our ability to speak is complex, and the role of the central nervous system in controlling speech production is often overlooked in the field of otolaryngology. In this brief review, we present an integrated overview of speech production with a focus on the role of central nervous system. The role of central control of voice production is then further discussed in relation to the potential pathophysiology of spasmodic dysphonia (SD).

Data Sources

Peer-review articles on central laryngeal control and SD were identified from PUBMED search. Selected articles were augmented with designated relevant publications.

Review Methods

Publications that discussed central and peripheral nervous system control of voice production and the central pathophysiology of laryngeal dystonia were chosen.

Results

Our ability to speak is regulated by specialized complex mechanisms coordinated by high-level cortical signaling, brainstem reflexes, peripheral nerves, muscles, and mucosal actions. Recent studies suggest that SD results from a primary central disturbance associated with dysfunction at our highest levels of central voice control. The efficacy of botulinum toxin in treating SD may not be limited solely to its local effect on laryngeal muscles and also may modulate the disorder at the level of the central nervous system.

Conclusion

Future therapeutic options that target the central nervous system may help modulate the underlying disorder in SD and allow clinicians to better understand the principal pathophysiology.

Level of Evidence

N/ALaryngoscope, 2017



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Novel murine xenograft model for the evaluation of stem cell therapy for profound dysphagia

Objectives/Hypothesis

Dysphagia is common and costly. Treatments are limited and innovative therapies are required. The tongue is essential for safe, effective swallowing and is a natural target for regenerative therapy. Muscle-derived stem cells (MDSCs) hold potential to restore dynamic function, and their application in the damaged tongue is appealing. We examined the safety and efficacy of human MDSC implantation into a novel mouse tongue model.

Study Design

Animal study.

Methods

Adult immune-deficient mice were randomized to surgical (hemiglossectomy) and nonsurgical groups. Animals underwent lingual injection of human MDSCs or saline (control). Groups were followed for 12 weeks. The primary outcome was MDSC survival measured by an in vivo imaging system (IVIS). Secondary outcomes included animal survival and weight. Comparisons were made using a Mann-Whitney U test with an α of .05.

Results

Human MDSCs survived to the endpoint demonstrating 132% ± 465% and 15% ± 11% bioluminescence by IVIS at 12 weeks in hemiglossectomy and nonsurgical groups, respectively. All but one animal (hemiglossectomy with saline injection) survived to the study endpoint. Mean weight increased from baseline in all groups, with the greatest change observed in hemiglossectomy mice with MDSC injection (baseline 24.5 g ± 3.9 g; delta 5.9 g ± 4.6 g), exceeding the weight gain seen in surgical control mice (baseline 24.9 g ± 4.2 g, delta 2.7 g ± 1.4 g) (P = .04).

Conclusions

MDSCs exhibited over 100% survival at 3 months when injected into an immune-deficient hemiglossectomy mouse model. Tongue-injured animals injected with MDSCs exhibited superior weight gain after hemiglossectomy than control animals (P < .05). These data support further investigation into the use of autologous MDSCs as a potential treatment for dysphagia secondary to tongue weakness and fibrosis

Level of Evidence

NA Laryngoscope, 2017



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Acoustic plus electric speech processing: Long-term results

Objective

Few studies have investigated the stability of residual hearing and speech perception outcomes in individuals who were implanted with a shorter electrode device.

Study Design

Longitudinal, single-subject design.

Methods

Fifty subjects who received a Nucleus Hybrid (Cochlear, Sydney, Australia) short electrode cochlear implant (CI) and had a minimum of 2 years (and up to 15 years) of postoperative longitudinal experience were included in this study. Twenty-three subjects received a Nucleus Hybrid S8 (S8); 14 subjects received a Nucleus Hybrid L24 (L24); and 13 received a Nucleus Hybrid S12 (S12). Audiometric thresholds and consonant-nucleus-consonant (CNC) words were collected pre- and postoperatively for up to 15 years for the S8 subjects and for up to 7 years for the S12 and L24 subjects. AzBio Sentences in multi-talker babble was collected for up to 7 years on the S12 and L24 subjects.

Results

Longitudinally, 83% of the S8 subjects, 92% of the S12 subjects, and 86% of the L24 subjects maintained a functional hearing pure-tone average (PTA) (125–500 Hz). Predicted change using a piecewise linear mixed model in PTA over time showed a postoperative linear decrease in hearing for each group until 0.5 years, after which the PTA stabilizes and is maintained. The averaged individual data for CNC and AzBio sentences show a significant improvement in scores by 0.25 to 0.5 years postimplantation, after which scores start to reach their maximum.

Conclusion

This long-term study demonstrates that acoustic-electric processing hearing and improvement in speech understanding in quiet and in noise can be accomplished and sustained for many years with a short electrode CI.

Level of Evidence

2C. Laryngoscope, 2017



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