The effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence to oral epithelial cells

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): T. Mafojane, S.L. Shangase, M. Patel
ObjectiveThis study investigated the effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence ability to oral epithelial cells.MethodsThirty strains of C. albicans isolated from denture wearers, normal healthy individuals and HIV positive patients were used in the study. The antifungal property (Minimum Fungicidal Concentration) of gentian violet was determined at various time intervals using a microdilution technique. The effect of subinhibitory concentrations of gentian violet on the adherence ability (0.000244%) and on germ tube formation ((0.000244%, 0.000122%, 0.000061% and 0.000031%) was determined. In both experiments, water was used as a control. The test results were compared using the Kruskal-Wallis test.ResultsAt 60min a high concentration (0.0078%) of gentian violet was required to completely kill C. albicans. Subinhibitory concentrations of gentian violet significantly reduced the adherence ability of C. albicans by 57% (p<0.01) and equally inhibited germ tube formation (p<0.01) compared with the controls. The inhibition was concentration dependent, with up to 98% reduction at a concentration of 0.000244%. Germ tube reduction was significantly higher in the isolates from the HIV positive patients than in the isolates from denture wearers.ConclusionAt high concentrations, gentian violet killed C. albicans, whereas at subinhibitory concentrations it reduced its virulence by preventing the adherence ability and germ tube formation. This suggests that the beneficial effects of gentian violet would last beyond the fungicidal concentrations in the treatment of candidiasis.

Graphical abstract

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The effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence to oral epithelial cells

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): T. Mafojane, S.L. Shangase, M. Patel
ObjectiveThis study investigated the effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence ability to oral epithelial cells.MethodsThirty strains of C. albicans isolated from denture wearers, normal healthy individuals and HIV positive patients were used in the study. The antifungal property (Minimum Fungicidal Concentration) of gentian violet was determined at various time intervals using a microdilution technique. The effect of subinhibitory concentrations of gentian violet on the adherence ability (0.000244%) and on germ tube formation ((0.000244%, 0.000122%, 0.000061% and 0.000031%) was determined. In both experiments, water was used as a control. The test results were compared using the Kruskal-Wallis test.ResultsAt 60min a high concentration (0.0078%) of gentian violet was required to completely kill C. albicans. Subinhibitory concentrations of gentian violet significantly reduced the adherence ability of C. albicans by 57% (p<0.01) and equally inhibited germ tube formation (p<0.01) compared with the controls. The inhibition was concentration dependent, with up to 98% reduction at a concentration of 0.000244%. Germ tube reduction was significantly higher in the isolates from the HIV positive patients than in the isolates from denture wearers.ConclusionAt high concentrations, gentian violet killed C. albicans, whereas at subinhibitory concentrations it reduced its virulence by preventing the adherence ability and germ tube formation. This suggests that the beneficial effects of gentian violet would last beyond the fungicidal concentrations in the treatment of candidiasis.

Graphical abstract

http://ift.tt/2skHG7l

Podcast Interviews

ATA Members give podcast interviews on Thyroid Topics at www.docthyroid.com

Información Importante Sobre los Nódulos Tiroideos con la Dra Regina Castro de la Clínica Mayo
Interviewed and produced by Philip James | May 4, 2017 | Endocrine, Pathology, Podcast

You Have a Thyroid Nodule, What Happens Next? with Dr. Regina Castro from The Mayo Clinic
Interviewed and produced by Philip James | Apr 2, 2017 | Pathology, Podcast, Surgery

 

The post Podcast Interviews appeared first on American Thyroid Association.

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The Role of Patients

Shared decision-making affords patients and their families the autonomy to make difficult decisions after receiving comprehensive information about medical facts and treatment options. It is essential that patients' values are respected. The essential steps include first informing patients of the need for a decision, then explaining the various facts involved; after which, it is important to elicit patients' preferences and goals. Once the treatment options and outcomes important to patients are identified, an actual decision can be made. This activity is complex and requires a commitment of time and is enhanced through employment of a multidisciplinary team approach.

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Decision Making for Diagnosis and Management

The diagnosis and treatment of head and neck cancer is extremely complex. As a result, multiple medical providers are involved in a patient's care, and the multidisciplinary tumor boards provide a forum whereby they can share and discuss the intricacies of each individual patient's case. When recommendations are presented to the patient and decisions are to be finalized, the patient should benefit from the collective wisdom of a team of providers to achieve and implement a patient-centric and clinically sound consensus.

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Fibrin sealant (Tisseel™) for mesh fixation in repair of the deep circumflex iliac artery (DCIA) free flap donor site

The iliac crest free flap, based on the deep circumflex iliac artery (DCIA) is well described and considered an excellent choice for composite reconstruction in the head and neck.1,2

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Rhabdomyosarcoma of the head and neck: impact of demographic and clinicopathologic factors on survival

Publication date: Available online 30 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Robert J. Lee, Kevin K. Lee, Thomas Lin, Armin Arshi, Serena A. Lee, Russell E. Christensen
ObjectiveTo determine the survival factors for patients diagnosed with rhabdomyosarcoma of the head and neck.Study DesignPatients diagnosed with rhabdomyosarcoma of the head and neck between 1973 and 2012 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier and Cox proportional hazard regression models were performed to determine the demographics, prognostic factors, and treatment modalities that determine overall survival (OS) and disease-specific survival (DSS).Results503 patients diagnosed with rhabdomyosarcoma of the head and neck were analyzed. 51.3% were male and 48.7% were female with a median OS of 4.9 years. Kaplan-Meier analysis determined 5-year survival rates of 30% for OS and 50% for DSS. Multivariate analysis found that age at diagnosis, tumor extent of disease, surgical resection, and radiation therapy were independent predictors of OS and DSS.ConclusionsThis study, to our knowledge, is the largest year span study to date determining the factors of survival for rhabdomyosarcoma of the head and neck. Older age at diagnosis, histological subtype of alveolar rhabdomyosarcoma, and further extent of disease were associated with decreased survival. Surgical resection improves survival in patients with localized or regional disease while radiation therapy confers survival benefit in patients with distant extent.



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Triggers of oral lichen planus flares and the potential role of trigger avoidance in disease management

Publication date: Available online 30 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hannah X. Chen, Rachel Blasiak, Edwin Kim, Ricardo Padilla, Donna A. Culton
ObjectiveMany patients with oral lichen planus (OLP) report triggers of flares, some of which overlap with triggers of other oral diseases including oral allergy syndrome and oral contact dermatitis. The purpose of this study was to evaluate the prevalence of commonly reported triggers of OLP flares, the overlap with triggers of other oral diseases, and the potential role of trigger avoidance as a management strategy.Study DesignQuestionnaire-based survey of 51 patients with biopsy-proven lichen planus with oral involvement seen in an academic Dermatology specialty clinic and/or Oral Pathology clinic between June 2014 and June 2015.ResultsOf the participants, 94% identified at least one trigger of their OLP flares. Approximately half of participants (51%) reported at least one trigger that overlapped with known triggers of oral allergy syndrome, and 63% identified at least one trigger that overlapped with known triggers of oral contact dermatitis. Emotional stress was the most commonly reported trigger (77%). Regarding avoidance, 79% of the study participants reported avoiding their known triggers in daily life. Of those who actively avoided triggers, 89% reported an improvement in symptoms and 70% reported a decrease in frequency of flares.ConclusionsTrigger identification and avoidance can play a potentially effective role in the management of OLP.



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Safer VL intubation: Don't lift or displace the tongue

Another tip for safer intubations.

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Flap Basics I

In many cases of complex facial defects, because of advanced cutaneous malignancies, primary wound closure is impossible. In these instances, ideal results can be obtained through recruitment of adjacent tissue with the use of local flaps. Advances in local flap techniques have raised the bar in facial reconstruction; however, acceptable results to surgeon and patient require high levels of planning and surgical technique. Defects resulting from Mohs surgery and other traumatic injuries can typically be repaired with local flaps. A well-planned and executed local flap can lead to excellent cosmetic results with minimal distortion of the surrounding facial landmarks.

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Anatomy of the Skin and the Pathogenesis of Nonmelanoma Skin Cancer

Skin is composed of the epidermis, dermis, and adnexal structures. The epidermis is composed of 4 layers—the stratums basale, spinosum, granulosum, and corneum. The dermis is divided into a superficial papillary dermis and deeper reticular dermis. Collagen and elastin within the reticular dermis are responsible for skin tensile strength and elasticity, respectively. The 2 most common kinds of nonmelanoma skin cancers are basal cell and squamous cell carcinoma. Both are caused by a host of environmental and genetic factors, although UV light exposure is the single greatest predisposing factor.

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Reconstruction of Cutaneous Nasal Defects

Mohs micrographic surgery has become the standard of care for the treatment of cutaneous malignancies. Reconstructing cutaneous defects of the nose can be challenging as form and function must be respected to the greatest extent possible. A wide range of reconstructive techniques are used. Secondary intent, primary closure, skin grafts, local flaps, and the interpolated workhorse flaps represent the spectrum of options, each with specific advantages and disadvantages. Vigilant postoperative care, including judicious use of adjunctive procedures, can improve outcomes. A subunit approach to reconstruction aids with surgical planning in order to achieve the best possible results.

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Scar Revision and Recontouring Post-Mohs Surgery

Following Mohs reconstruction, several options are available to improve the appearance of the resulting scars. It is critical that the patient has realistic goals before beginning any treatment because scars can be improved but never erased. The surgical and nonsurgical options aim to replace pre-existing scars with ones that are less conspicuous. This article addresses the different available options (listed in order of invasiveness) for improving scarring following Mohs reconstruction.

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The Physiology and Biomechanics of Skin Flaps

Facial skin defects created by Mohs micrographic surgery are commonly reconstructed using local cutaneous flaps from surrounding skin. To provide optimal survival and aesthetic outcomes, the cutaneous surgeon must command a thorough understanding of the complex vascular anatomy and physiology of the skin as well as the imperative physiologic and biomechanical considerations when elevating and transferring tissue via local skin flaps.

http://ift.tt/2rlFrUa

Speech-evoked auditory brainstem responses in children with hearing loss

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Amineh Koravand, Rida Al Osman, Véronique Rivest, Catherine Poulin
ObjectiveThe main objective of the present study was to investigate subcortical auditory processing in children with sensorineural hearing loss.MethodsAuditory Brainstem Responses (ABRs) were recorded using click and speech/da/stimuli. Twenty-five children, aged 6–14 years old, participated in the study: 13 with normal hearing acuity and 12 with sensorineural hearing loss.ResultsNo significant differences were observed for the click-evoked ABRs between normal hearing and hearing-impaired groups. For the speech-evoked ABRs, no significant differences were found for the latencies of the following responses between the two groups: onset (V and A), transition (C), one of the steady-state wave (F), and offset (O). However, the latency of the steady-state waves (D and E) was significantly longer for the hearing-impaired compared to the normal hearing group. Furthermore, the amplitude of the offset wave O and of the envelope frequency response (EFR) of the speech-evoked ABRs was significantly larger for the hearing-impaired compared to the normal hearing group.ConclusionsResults obtained from the speech-evoked ABRs suggest that children with a mild to moderately-severe sensorineural hearing loss have a specific pattern of subcortical auditory processing. Our results show differences for the speech-evoked ABRs in normal hearing children compared to hearing-impaired children. These results add to the body of the literature on how children with hearing loss process speech at the brainstem level.



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Glucosamine has an antiallergic effect in mice with allergic asthma and rhinitis

Background

Glucosamine (GlcN) is generally used as a dietary supplement because of its antiinflammatory effects. We evaluated the antiallergic effect of GlcN in mice with allergic asthma and rhinitis.

Methods

Thirty-two mice were allocated equally into 4 groups (n = 8). In group A (control), we performed intraperitoneal/intranasal challenge using sterile saline. In group B (asthma/rhinitis), we used ovalbumin for intraperitoneal/intranasal challenge to induce allergic asthma and rhinitis. In groups C and D (GlcN treatment), mice were given 1% and 5% GlcN throughout the period of ovalbumin challenge, respectively. We measured serum total and ovalbumin-specific immunoglobulin E (IgE), cytokine titers (interleukin-1, -4, -5, -6, -10, and -17; tumor necrosis factor-α; and interferon-γ), and the number of inflammatory cells (eosinophils, neutrophils, lymphocytes) in bronchoalveolar lavage (BAL) fluid. We also performed histopathologic examination of the lung and nasal cavity. Finally, we performed real-time polymerase chain reaction for the genes Bcl-2, EC-SOD, VEGF, caspase-3, Bax, COX-2, Hif-1α, and heme oxygenase-1.

Results

Compared with group B, group D had significant serum total and ovalbumin-specific IgE decreases after GlcN treatment (p < 0.05). Titers for IL-4, IL-5, IL-6, and IL-17 in BAL fluid were significantly decreased in group D (p < 0.05). Eosinophils in BAL fluid were significantly decreased in group D compared with group B (p < 0.05). Groups C and D showed significant improvement of inflammation compared with group B. Group D had significant downregulation of EC-SOD, Bax, Hif-1α, and heme oxygenase-1 compared with group B.

Conclusion

GlcN had a significant antiallergic effect in mice with allergic asthma and rhinitis.

http://ift.tt/2sbuLFl

Safety and efficacy of a bioabsorbable fluticasone propionate–eluting sinus dressing in postoperative management of endoscopic sinus surgery: a randomized clinical trial

Background

Postoperative wound healing after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) is an important factor in procedural success. Local steroids and separation of opposing mucosa are commonly implemented to optimize healing. A bioabsorbable, fluticasone propionate (FP)-eluting implant, SinuBand FP, was assessed for its safety and efficacy when used in patients with CRS and nasal polyps, who were indicated for ESS including bilateral anterior and posterior ethmoidectomy.

Methods

A first-in-human, randomized, partially double-blind, single-tertiary-referral-center, controlled trial enrolling 30 patients receiving 2 of 3 treatments (1 per sinus, intrapatient control): SinuBand FP, SinuBand (without FP), or standard nasal pack (Merocel®). Primary outcome measures were local safety, ocular safety (intraocular pressure [IOP], lens opacity), and 24-hour urine cortisol. Secondary measures (evaluated by independent review of postoperative video endoscopies) were ethmoid inflammation, polyp score, adhesion formation, and Lund-Kennedy score. Patient-reported outcomes of postoperative pain, nasal congestion, and nasal discharge were collected.

Results

Of 30 enrolled patients (used for safety analysis), 27 patients completed the trial. SinuBand FP showed local safety, ocular safety, and no significant change in 24-hour urine cortisol. SinuBand FP showed a trend to do better concerning inflammation. Concerning polyp score SinuBand FP did significantly better compared to Merocel (p = 0.03). No significance compared to SinuBand without corticosteroids (p = 0.97). Adhesions were comparable across treatments. Patient reported pain was nominally lower in the SinuBand group.

Conclusion

SinuBand FP was well tolerated and showed evidence of efficacy. A larger study is needed to further evaluate and confirm the benefits of SinuBand FP.

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Safety and tolerability of surfactant nasal irrigation

Background

Abnormal mucus composition and bacterial biofilms are thought to contribute to the pathophysiology of rhinosinusitis. Addition of a mucoactive surfactant to saline irrigation solution has been hypothesized to address these factors. We evaluated the safety and tolerability of a reformulated surfactant in a sample of normal subjects.

Methods

A total of 33 volunteers were randomly assigned to receive either surfactant solution or buffered saline at baseline in a controlled crossover study design. Each subject underwent rhinoscopic exam and in-office smell testing via the 40-question smell identification test (SIT). Those with non-normosmic results or active rhinitis symptoms were excluded. Subjects were instructed to irrigate twice daily with the selected solution for 1 week while keeping a daily diary. For week 2, treatment was stopped. During week 3, each group switched to the other treatment. Exam, SIT, and degree of congestion were assessed after each phase.

Results

Use of surfactant led to a marginal reduction in mean SIT score of 1.5 points, which was statistically significant (p = 0.012). A clinically meaningful reduction in SIT score, defined as ≥4 points, was observed in 18% (6/33) of subjects after surfactant vs 3% (1/33) after saline (p = 0.046). During the surfactant phase, moderate or severe congestion was reported in 29% (8/28) of subjects completing the diary. In contrast, only 6% (2/32) of subjects reported moderate congestion after the saline phase (p = 0.021).

Conclusion

In normal volunteers, surfactant nasal irrigation may be associated with tolerability issues due to congestion. A subset may experience reduction in olfactory acuity that appears reversible.

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Safer Intubation Tip #5

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Disease activity and mucosal healing in inflammatory bowel disease: a new role for histopathology?

Abstract

Histologic evaluation of disease activity in the setting of inflammatory bowel disease is gaining interest within the gastroenterology community. Recent data suggests that histologic measurements of inflammation in ulcerative colitis are more sensitive at detecting disease activity and perform better than endoscopic measurements in predicting clinical outcomes. Histologic measurements are also increasingly used in ulcerative colitis clinical trials to assess response to new therapies. Histologic measurements of disease activity are less well studied in Crohn's disease, but are gaining attention. Current published treatment algorithms in inflammatory bowel disease do not take into consideration histologic activity; however, this may change in the near future. In order for histologic measurements to be included in clinical decision-making, validated, reliable, and responsive histologic scoring systems are needed. In this review, the recent literature on the significance of histologic activity in both ulcerative colitis and Crohn's disease is summarized. Histologic scoring systems are also briefly discussed.

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SMARCA4-deficient pulmonary adenocarcinoma: clinicopathological, immunohistochemical, and molecular characteristics of a novel aggressive neoplasm with a consistent TTF1 neg /CK7 pos /HepPar-1 pos immunophenotype

Abstract

Alterations in SMARCA4, a member of the chromatin remodeling Switch Sucrose Non-Fermentable (SWI/SNF) complex, characterize a subset of non-small cell lung cancer (NSCLC), but detailed morphological and immunophenotypic description of this tumor type is lacking. We describe 20 NSCLC cases found on routine screening not to express SMARCA4 by immunohistochemistry (IHC). These tumors were stained for CK7, TTF1, SMARCA2, SMARCA4, SMARCB1, and HepPar-1 and analyzed for molecular alterations, using a 160 cancer-related gene panel including the full coding sequence of SMARCA4. Patients were eight females and 12 males aged 41 to 76 (median, 60). Of 18 tumors with detailed data, 14 presented with synchronous distant metastases (M1). Histological examination showed predominantly solid adenocarcinoma (n = 15), frankly rhabdoid (n = 3) and mucinous (n = 2) patterns. Except for the rhabdoid cases, all tumors showed at least focal unequivocal glands and lacked squamous differentiation, justifying a diagnosis of adenocarcinoma. IHC showed a distinctive uniform immunophenotype (CK7⁺/HepPar-1⁺/TTF1⁻) in 18/20 cases. Only 2/16 cases showed limited weak expression of neuroendocrine markers. EGFR mutations and EML4-ALK and ROS1 gene rearrangements were not found in any of the examined cases. Next-generation sequencing, using a 160 cancer-related gene panel, revealed concurrent SMARCA4 and TP53 mutations in nine of the 12 (75%) successfully tested cases. Our study highlights (1) the morphological diversity of SMARCA4-deficient lung adenocarcinoma, (2) the consistent absence of expression of TTF1 in the presence of expression of HepPar-1, (3) absence of EGFR driver mutations, and (4) frequent inactivating SMARCA4 mutations as underlying mechanism of the observed SMARCA4 protein loss. SMARCA4-deficient pulmonary adenocarcinoma is emerging as a distinctive, albeit phenotypically heterogeneous molecular subgroup of TTF1-negative NSCLC. Uniform HepPar-1 expression in this subset of NSCLC may represent a diagnostic pitfall and merits further studies to explore the mechanisms involved.

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Comparative evaluation of insertion torque and mechanical stability for self-tapping and self-drilling orthodontic miniscrews – an in vitro study

Abstract

Background

The aim of the present study was to evaluate the relationship between insertion torque and stability of miniscrews in terms of resistance against dislocation, then comparing a self-tapping screw with a self-drilling one.

Methods

Insertion torque was measured during placement of 30 self-drilling and 31 self-tapping stainless steel miniscrews (Leone SpA, Sesto Fiorentino, Italy) in synthetic bone blocks. Then, an increasing pulling force was applied at an angle of 90° and 45°, and the displacement of the miniscrews was recorded.

Results

The statistical analysis showed a statistically significant difference between the mean Maximum Insertion Torque (MIT) observed in the two groups and showed that force angulation and MIT have a statistically significant effect on miniscrews stability. For both the miniscrews, an angle of 90° between miniscrew and loading force is preferable in terms of stability.

Conclusions

The tested self-drilling orthodontic miniscrews showed higher MIT and greater resistance against dislocation than the self-tapping ones.

http://ift.tt/2qCZfOC

QUILT-3.047: NANT Head and Neck Squamous Cell Carcinoma (HNSCC) Vaccine: Combination Immunotherapy in Subjects With HNSCC Who Have Progressed on or After Chemotherapy and PD-1/PD-L1 Therapy

Condition:   Head and Neck Squamous Cell Carcinoma
Interventions:   Biological: Avelumab;   Biological: Bevacizumab;   Drug: Capecitabine;   Biological: Cetuximab;   Drug: Cisplatin;   Drug: cyclophosphamide;   Drug: 5-Fluorouracil (5-FU);   Drug: fulvestrant;   Drug: leucovorin;   Drug: nab-paclitaxel;   Biological: nivolumab;   Drug: Lovaza;   Radiation: Stereotactic Body Radiation Therapy;   Biological: ALT-803;   Biological: ETBX-011;   Biological: ETBX-021;   Biological: ETBX-051;   Biological: ETBX-061;   Biological: GI-4000;   Biological: GI-6207;   Biological: GI-6301;   Biological: haNK
Sponsor:   NantCell, Inc.
Not yet recruiting - verified May 2017

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Phase 2 Trial of Apatinib Mesylate in Locally Advanced/Metastatic Differentiated Thyroid Carcinoma

Condition:   Differentiated Thyroid Carcinoma
Intervention:   Drug: Apatinib Mesylate
Sponsor:   Tianjin Medical University Cancer Institute and Hospital
Recruiting - verified March 2017

http://ift.tt/2rkFgIO

"Model for Early Allograft Function" outperforms "Early Allograft Dysfunction" as a predictor of transplant survival.

Background: The Model of Early Allograft Function (MEAF) grades the severity of liver graft dysfunction. Unlike the categorical Early Allograft Dysfunction (EAD) classification, MEAF is a continuous score, based on bilirubin, international normalised ratio, and alanine aminotransferase within 3 days posttransplant. Methods: Multivariable regression models were used to validate the MEAF score in 660 liver-only transplants performed between 2000-2014. MEAF performance for prediction of transplant survival was compared with that of EAD in univariable and multivariable models by means of Harrell's c-indices, integrated discrimination improvement, and net reclassification improvement. Results: Median donor and recipient age was 52y (IQR 41-62) and 58y (50-64), respectively. MELD-score was 15 (11-21), cold ischemia time 8.0h (6.4-9.7), MEAF 4 (3-6). EAD occurred in 182 (27.6%) cases. Transplant survival was 93%, 90%, and 88% at 3, 6, and 12 months. Both MEAF and EAD were independent predictors of transplant survival within 3, 6, and 12 months. MEAF outperformed EAD as predictor of transplant survival, either when used as a standalone parameter or when corrected for additional independent predictors of transplant survival. Conclusion: MEAF is a more accurate predictor of transplant loss than the commonly used EAD classification. As a continuous score grading graft dysfunction, MEAF provides additional, granulated information that could be used both clinically and as a surrogate endpoint of transplant survival in clinical trials. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Plasma Exosomes from HLA-Sensitized Kidney Transplant Recipients Contain mRNA Transcripts Which Predict Development of Antibody-Mediated Rejection.

Background: Sensitization to human leukocyte antigens (HLA) remains a significant immunologic barrier to successful transplantation. Identifying immune mechanisms responsible for antibody-mediated rejection (ABMR) is an important goal. Here we explored the possibility of predicting the risk for ABMR by measuring mRNA transcripts of ABMR-associated genes in plasma exosomes from kidney transplant patients. Methods: Total RNA was extracted from exosomes purified from 152 EDTA-plasma samples of 64 patients (18 ABMR, 8 cell-mediated rejection [CMR], 38 no rejection in desensitized (DES) and non-desensitized (non-DES) control groups) for reverse transcription into cDNA, preamplification and then real time quantitative polymerase chain reaction (qPCR) for 21 candidate genes. The mRNA transcript levels of each gene were calculated. Comparisons were made among 4 patient groups for each gene and also for a gene combination score based on selected genes. Results: Among 21 candidate genes, we identified multiple genes (gp130, CCL4, TNF[alpha], SH2D1B, CAV1, DARC) whose mRNA transcript levels in plasma exosomes significantly increased among ABMR compared to CMR and/or control patients. A gene combination score calculated from 4 genes of gp130, SH2D1B, TNF[alpha] and CCL4 was significantly higher in the ABMR than the CMR (p

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Comparative Evaluation of [alpha]CD40 (2C10R4) and [alpha]CD154 (5C8H1 and IDEC-131) in a Nonhuman Primate Cardiac Allotransplant Model.

Background: Specific blockade of T cell costimulation pathway is a promising immunomodulatory approach being developed to replace our current clinical immunosuppression therapies. The goal of this study is to compare results associated with 3 monoclonal antibodies directed against the CD40/CD154 T cell costimulation pathway. Methods: Cynomolgus monkey heterotopic cardiac allograft recipients were treated with either IDEC-131 (humanized [alpha]CD154, n=9), 5C8H1 (mouse-human chimeric [alpha]CD154, n=5), or 2C10R4 (mouse-rhesus chimeric [alpha]CD40, n=6) monotherapy using a consistent, comparable dosing regimen for 3 months after transplant. Results: Relative to the previously reported IDEC-131 treated allografts, median survival time (MST 35+/-31 days) was significantly prolonged in both 5C8H1 (142+/-26, p

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A Dissimilar Biosimilar?: Lichenoid Drug Eruption Induced by an Infliximab Biosimilar

The advent of therapeutic antibodies, or biologic medications, has transformed our treatment of many inflammatory diseases in dermatology. Recently, the development of biosimilars, biologic drugs that are highly similar in quality, safety, and efficacy to approved biologics, has changed this landscape. Although biosimilars are not identical to their reference product, they are required to have the same mechanism of action, route of administration, dosage form, and strength as the reference product. This also leads to the possibility that subtle differences in the activity of these biosimilars can lead to differing clinical responses. We report the first case of a lichenoid eruption induced by a biosimilar to Infliximab after switching from infliximab. Several days after her initial infusion of the biosimilar, the patient developed a pruritic papulosquamous eruption that was biopsied to reveal a lichenoid drug eruption. Possible mechanisms for lichenoid drug eruptions as a result of TNF-alpha inhibitor administration are discussed, along with reasons why such a reaction may occur with a biosimilar but not the original, reference product. This case report calls attention to the unique differences between biosimilars and biologic medications that a clinician should consider prior to prescribing these medications.

This article is protected by copyright. All rights reserved.

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Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer

Abstract

Background

Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation.

Methods

A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed.

Results

A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides.

Conclusion

Preserving cervical nerves in neck dissection is oncologically safe in selected cases.

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Evolving trends in head and neck cancer epidemiology: Ontario, Canada 1993-2010

Abstract

Background

Given the dramatic changes in global head and neck cancer epidemiology, the purpose of this study was to present the findings of our investigation on patterns of head and neck cancer incidence/survival within the province of Ontario, Canada.

Methods

Temporal variations in age/sex adjusted incidence and survival were analyzed for all incident head and neck cancer cases (n = 20 781) managed within Ontario from 1993-2010.

Results

From 1993-2010, the incidence of oropharyngeal (average annual percentage change [AAPC] 4.56%; P < .001) and salivary gland (AAPC 4.99%; P < .001) carcinomas increased, whereas oral cavity (AAPC -1.44%; P < .001) and laryngeal/hypopharyngeal (AAPC -3.20%; P < .001) carcinomas declined, and nasopharyngeal carcinoma (NPC) remained static (AAPC 0.28%; P = .72). A general trend for improved 5-year overall survival (OS), was observed for all tumor sites.

Conclusion

Consistent with previous studies, our results suggest a simultaneous decline in tobacco-associated and increase in human papillomavirus (HPV)-mediated carcinomas. The rising incidence of salivary malignancy and improvement in 5-year OS are novel findings, in need of future investigation.

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Salvage surgery for oropharyngeal squamous cell carcinomas: a retrospective study from 2005 to 2013

Abstract

Background

In the case of a locoregional recurrence of oropharyngeal squamous cell carcinoma, the curative standard of care is surgery. Our main purpose of this study was to determine the preoperative prognostic factors that would allow us to select the patients on whom we could expect good results with salvage surgery.

Methods

We conducted a monocentric retrospective study from 2005 to 2013. It included all patients treated for a recurrence of oropharyngeal squamous cell carcinoma with surgery. Their initial treatment included radiotherapy.

Results

Fifty-two patients were included. Poor prognostic factors for survival were the cT status (P = .0039) and local recurrences versus secondary localizations in irradiated areas (P = .016) and a relapse less than a year after the end of the initial treatment (P = .050). Recurrence-free survival was 19% at 5 years. Twenty-nine percent of patients presented local complications, which were mainly fistulas and hemorrhaging at the surgical site.

Conclusion

According to the high morbimortality, it is important to carefully select the right patients for surgery.

http://ift.tt/2qx3ufs

Giant pyogenic granuloma of the finger in an HIV-positive patient

Abstract

Pyogenic granuloma (PG) is an acquired vascular lesion that affects the skin and mucosa. The term Lobular Capillary Hemangioma was subsequently adopted to more accurately reflect its biologic and histopathologic nature [1]. Clinically, PGs usually appear as single, small, red papules with a marked tendency for bleeding. Giant PGs are exceedingly rare with only a handful of reported cases. Here we report the second case of a giant PG arising in an HIV-positive patient [2].

This article is protected by copyright. All rights reserved.

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Shallow Anterior Chamber in a Severe Case of Unilateral Acute Central Serous Retinal Detachment

Background: Atypical serous chorioretinopathy can present with symptoms similar to those of other pachychoroid diseases; however, a proper differential diagnosis will prevent unnecessary intensive treatments. To this end, we report on the shallowness of anterior chamber and transitory anterior vitreous cells in a patient with atypical severe serous retinal detachment. Case Presentation: A 42-year-old woman presented with unilateral visual loss accompanied by mild, vague eye pain for 4 days. Spectral-domain OCT scans of the left eye showed macular and peripapillary serous detachment. Optical biometry showed the clinically significant shallow anterior chamber. Conclusions: Severe central serous chorioretinopathy can show up in an atypical fashion with macular, extramacular, juxtapapillary serous detachments, temporary existence of anterior vitreous cells, clinically detectable decreased anterior chamber depth, and mild eye pain of short duration.
Case Rep Ophthalmol 2017;8:326–333

http://ift.tt/2qxpXZT

Successful treatment of pneumatosis intestinalis with associated pneumoperitoneum and ileus with hyperbaric oxygen therapy

Pneumatosis intestinalis (PI), or the presence of air in the bowel wall, is a rare disorder that is associated with a variety of underlying diseases, including connective tissue disorders. PI presents on a spectrum from asymptomatic to bowel obstruction and acute abdomen. In general, treatment of PI consists of treating the underlying disease. Both normobaric and hyperbaric oxygen have been used to treat PI directly. Here we report a symptomatic scleroderma-related case of PI that responded clinically to hyperbaric oxygen therapy. This report adds to a growing body of literature supporting a role for hyperbaric oxygen therapy in symptomatic PI.

http://ift.tt/2shmVJC

Occult myeloproliferative neoplasms: not so occult any more

Non-cirrhotic, non-malignant portal vein thrombosis (PVT) is commonly secondary to inherited or acquired prothrombotic states. However, even after extensive workup, 25% of patients with PVT have no apparent prothrombotic aetiology identified (idiopathic PVT). Inherited conditions include factor V Leiden, PT mutation and protein C/S/AT deficiency. Acquired conditions include APS, PNH and BCR-ABL 1-negative myeloproliferative neoplasms (MPN). BCR-ABL-1 negative MPNs are the most frequent underlying prothrombotic risk factor for PVT (15%–30%). However, peripheral blood counts often remain within normal ranges in these patients with MPN because of portal hypertension sequel. Despite suggestive features of MPN in bone marrow, these patients lack adequate diagnostic criteria and are classified as occult MPN. The discovery of recurrent molecular abnormalities such as CALR gene exon 9 mutation presented a crucial advance in the diagnosis of occult MPNs. In our patient, the diagnosis of MPN was made on this basis, despite lack of peripheral evidence of MPN.

http://ift.tt/2rjcojO

La dermatose érosive et pustuleuse

Publication date: Available online 29 May 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Truchetet




http://ift.tt/2qvxyML

Lugol's solution-induced painless thyroiditis

Summary

Lugol's solution is usually employed for a limited period for thyroidectomy preparation in patients with Graves' disease and for the control of severe thyrotoxicosis and thyroid storm. We describe a rare case of Lugol's solution-induced painless thyroiditis. In November 2014, a 59-year-old woman was prescribed Lugol's solution four drops per day for the alleviation of menopausal symptoms. She was referred to our clinic in June 2015 for fatigue, hair loss, and a 20-lb weight loss without thyroid pain or discomfort. Physical examination revealed a normal thyroid gland. On 7 May 2015, laboratory tests revealed a suppressed thyroid-stimulating hormone (TSH) 0.01 U/L with elevated free T4 3.31 ng/dL (42.54 pmol/L). Repeat testing on 25 May 2015 showed spontaneous normalization of the free thyroid hormone levels with persistently low TSH 0.10 U/L. Following these results, a family physician prescribed methimazole 10 mg PO TID and very soon after, the TSH concentration rose to >100 U/L along with subnormal free T4 and T3 levels. Methimazole was promptly discontinued, namely within 18 days of its initiation. Over the course of the next few months, the patient spontaneously achieved clinical and biochemical euthyroidism. To our knowledge, this is a unique case of painless thyroiditis induced by Lugol's solution, which has not been reported before. Lugol's solution is a short-term medication given for the preparation of thyroidectomy in patients with Graves' disease and for the control of severe thyrotoxicosis. Iodine excess can cause both hyperthyroidism and hypothyroidism. Rarely, Lugol's solution can cause acute painless thyroiditis.

Learning points:

Lugol's solution is used for thyroidectomy preparation in patients with Graves' disease and for the control of severe thyrotoxicosis and thyroid storm.

Iodine excess can cause both hypothyroidism and thyrotoxicosis. Thyroid glands with an underlying pathology are particularly susceptible to the adverse effect of iodine.

The prolonged off-label use of Lugol's solution can be harmful. Rarely, Lugol's solution can cause acute painful thyroiditis.

http://ift.tt/2sa0EOD

“Influence of possible predictor variables on the outcome of primary oral squamous cell carcinoma: a retrospective study of 392 consecutive cases at a single centre”— methodological issues

Publication date: Available online 29 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. Pakzad, S. Safiri




http://ift.tt/2sh2mNl

Starvation before surgery: is our practice based on evidence?

2A033I00

http://ift.tt/2rfbV0f

Prenatal Diagnosis of Atrioventricular Block and QT Interval Prolongation by Fetal Magnetocardiography in a Fetus with Trisomy 18 and SCN5A R1193Q Variant

We report a case of fetal trisomy 18 with SCN5A R1193Q variant that presented with sinus bradycardia, 2 : 1 atrioventricular block (AVB), and QT interval prolongation. These complex arrhythmias were diagnosed by fetal magnetocardiography combined with ultrasound findings. Advanced AVB and ventricular arrhythmias were confirmed after birth. Genetic testing of the baby revealed a SCN5A R1193Q variant, which we considered could account for the various arrhythmias in this case.

http://ift.tt/2rQ7fk5

Decisions to limit or withdraw treatment in young adults with melanoma

Abstract

melanoma reaches the highest mortality rate by cancer among young men (ages 20-34) in France (1). A recent study suggests that age does not affect survival in patients with advanced disease (3). The prognosis of patients with metastatic or stage IV melanoma is grim, with a 1-year survival rate of 25% and a median overall survival of 6.2 months (2).

This article is protected by copyright. All rights reserved.

http://ift.tt/2rQnyNH

Acne: morphologic and vascular study of lesions and surrounding skin by means of optical coherence tomography

Abstract

Background

Acne vulgaris is a disease of the pilosebaceous unit, characterized by hyper-keratinization process, comedos formation and inflammatory reactions.

Objective

The definition of the morphology and the vascularization of acne lesions by means of dynamic optical coherence tomography (D-OCT), in order to non-invasively define the alterations occurring during the acne development and patient therapeutic management.

Methods

A set of standardized clinical pictures and D-OCT images were acquired from 114 acne lesions of 31 volunteers, presenting mild to moderate acne and evaluated by experts. Fifteen patients treated with oral antibiotics were followed during time at 0, 20, 40, and 60 days.

Results

Optical coherence tomography enabled to identify vascular and morphological aspects characterizing different types of acne lesions. Oral antibiotic treatment improved the morphologic features and decreased the digitally reconstructed vascular signal during time.

Conclusion

The characterization of acne lesions and the identification of vascular pattern in acne lesions through D-OCT, corresponding to blood vessel dilation and inflammatory associated hyper-vascularization, may have important clinical consequences in the assessment of acne severity, therapeutic decisions and treatment efficacy monitoring.

This article is protected by copyright. All rights reserved.

http://ift.tt/2qwvn7o

Ponatinib-induced widespread ichthyosiform eruption

Abstract

Ponatinib is a new potent third-generation tyrosine kinase inhibitor (TKI), developed for the treatment of chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphocytic leukaemia (ALL) resistant to first (imatinib) and second generation (dasatinib and nilotinib) TK-inhibitors. Aimed at wild type and mutant BCR-ABL, ponatinib demonstrates significant anti-leukemic activity and holds much promise in treating other malignancies, including gastrointestinal stromal tumors (GIST)(1;2).

This article is protected by copyright. All rights reserved.

http://ift.tt/2rQ9wvI

Prediction of thirty-year cardiovascular disease risk in psoriatic population

Abstract

In psoriatic population the Framingham risk score (FRS) has been used to assess the risk of major cardiovascular (CV) events for a 10-year follow up period^1-6. The established CV risk factors that are significant in models based on shorter follow-up duration are also related to CV disease (CVD) incidence in 30 years^7-8. Nowadays, clustering of risk factors at younger ages and increasing life expectancy suggest the need for longer-term risk prediction tools.

This article is protected by copyright. All rights reserved.

http://ift.tt/2qwNUQY

Drug concentration and antidrug antibodies in patients with psoriasis treated with adalimumab or etanercept

Abstract

Tumour necrosis factor (TNF)-α antagonists are used for treatment of psoriasis and are generally effective and well tolerated (1,2). However, a substantial proportion of patients lose effect over time. The underlying mechanisms are unclear, but data suggest that formation of anti-drug antibodies leads to sub-therapeutic drug levels and thereby loss of efficacy (3).

This article is protected by copyright. All rights reserved.

http://ift.tt/2rQf21h

Dose-Escalation Study Evaluating Pegylated Interferon Alpha-2a in Patients with Cutaneous T-Cell Lymphoma

Abstract

Background

This open-label, multicenter, dose-escalation study evaluated the safety, tolerability, and efficacy of subcutaneous pegylated (40 kD) interferon α-2a (PEG-IFN α-2a) in patients with cutaneous T-cell lymphoma (CTCL).

Patients and Methods

PEG-IFNα-2a was administered subcutaneously at 180 (n=4), 270 (n=6), or 360 μg (n=3) once weekly for 12 weeks. Efficacy was assessed by the proportion of patients with complete response (CR) or partial response (PR).

Results

PEG-IFNα-2a was generally well tolerated, with a moderate number of reductions or withholding of doses because of adverse events (25% (n=1), 66% (n=4), and 0% (n=0) in the 180, 270, and 360-μg/week groups, respectively). The only dose-limiting toxicity was a grade 3 elevation of liver enzymes in the 270μg dose group. The most common adverse events were fatigue, acute flu-like symptoms, and hepatic toxicity. The major response rate (CR or PR) was 50% in the 180-μg group (CR, 50%; PR, 0%), 83% in the 270-μg group (CR, 67%; PR, 17%), and 66% in the 360-μg group (CR, 33%; PR, 33%).

Conclusion

PEG-IFNα-2a at doses up to 360 μg once weekly was well tolerated in patients with CTCL up to the highest dose group and showed good response rates. Due to their good tolerance even in high doses they might be an option for patients not toleratingstandard IFNα preparations. However, for this purpose and to evaluate comparability between standard and PEG-IFN larger clinical trials are needed, alone and in combination with oral photochemotherapy (PUVA).

This article is protected by copyright. All rights reserved.

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Psoriasis in patients with Mycosis Fungoides: Α clinicopathological study of 25 patients

Abstract

Background

It has been reported that patients with psoriasis are at increased risk for developing lymphoma including cutaneous T cell lymphomas (CTCL). However, the comorbidity and the histopathologic correlation of psoriasis and Mycosis Fungoides (MF) have been less studied.

Objective

The objective of the current study was to investigate the relation between mycosis fungoides (MF) and psoriasis.

Methods

We retrospectively reviewed and reevaluated all MF cases diagnosed and followed in a 16 year period who carried both MF and psoriasis diagnoses.

Results

Forty-one out of 321 MF patients was the rate of psoriasis' comorbidity according to medical records. Twenty-five patients (7.8%) finally met the inclusion criteria. The rest were excluded due to inadequate evidence. Twenty patients had psoriatic lesions at the time of MF diagnosis. In 23 patients there was histological confirmation of both diseases. Six patients (24%) were diagnosed with folliculotropic MF, 2 were diagnosed with pustular psoriasis and 6 patients were affected by palmoplantar and nail psoriasis. In 4 patients there was a very short time interval between MF and psoriasis diagnosis. Fourteen patients with psoriasis had been previously treated with immunomodulatory regimens. Interestingly, in 8 patients typical histological findings of both diseases were detected in the same biopsy specimen.

Conclusion

Our results support the opinion that the association between psoriasis and MF does exist. It is most possibly related to the chronic lymphocyte stimulation that occurs during psoriasis that eventually leads to a dominant clone and the evolution to CTCL. Our study suggests that apart from cases of early MF, which are being indeed misdiagnosed as psoriasis, there is another group of patients, where psoriasis truly coexists with- or even progresses to-MF.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rQe9pu

Tumor-stage mycosis fungoides regressing with milia and pustules after total skin electron beam therapy

Abstract

A healthy 66 year-old man presented with a three-year history of a skin eruption, initially treated as psoriasis without response. A biopsy was subsequently performed that was consistent with mycosis fungoides (MF). This diagnosis was confirmed with a positive T-cell gene rearrangement. The patient was referred to our institution for management of tumor stage MF.

This article is protected by copyright. All rights reserved.

http://ift.tt/2qwDX6f

Major response to pembrolizumab in two patients with locally advanced cutaneous squamous cell carcinoma

Abstract

Cutaneous squamous cell carcinomas (CSCC) are one of the most frequent types of cancer, with rising incidence rates(1). While the majority are cured with surgery, some CSCC are associated with significant morbidity and mortality due to their local extension and metastatic potential. The recommended treatment for these advanced stages includes radiotherapy, conventional chemotherapy, or cetuximab, which tends to yield modest responses and a high prevalence of toxic effects(2). Anti- Programmed Death-1 (PD-1) therapies recently showed their efficacy in several types of tumour, especially in patients with recurrent or metastatic head and neck squamous cell carcinomas that has continued to progress despite standard-of-care treatment, suggesting the potentical efficacy of anti-PD1 in CSCC (3,4).

This article is protected by copyright. All rights reserved.

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Influence of TNF alpha inhibitors and fumaric acid esters on male fertility in psoriasis patients

Abstract

Objective

Is there any influence of a therapy with TNF alpha inhibitors or fumaric acid esters and of disease activity status on male fertility and sperm quality in psoriasis patients?.

Methods

In this monocentric, open-label, prospective study, semen samples were collected from patients receiving either TNF alpha inhibitors or fumaric acid esters for moderate to severe plaque psoriasis. Semen was analysed at baseline before onset of the systemic therapy and monitored every three months under therapy. Sperm parameters were assessed according to the current WHO definitions.

Results

In total, 101 semen specimens from 27 patients were obtained. Mean Psoriasis Area and Severity Index (PASI) score at baseline was 11.05. Only 14.8% of patients showed a normozoospermia without any other abnormal seminal values. 85.2% of patients had at least one sperm/seminal abnormality, including two patients showing an azoospermia. Interestingly, 48.1% showed sperm parameters indicative of genital tract inflammation. Therapy with TNF alpha inhibitors or fumaric acid esters did not have any negative effects on relevant sperm parameters like mean total sperm number, sperm concentration, total and progressive motility. No major gonadal dysfunction was observed in any patient.

Conclusion

At baseline, many psoriasis patients showed abnormal semen/sperm parameters and remarkably elevated leukocytes and values of seminal polymorphonuclear elastase, indicating a genital tract inflammation. Thus, genital tract inflammation may represent an important comorbidity of psoriasis, little attention paid to so far. Regarding treatment with TNF alpha inhibitors or fumaric acid esters, no major negative (side-) effects on sperm quality were observed.

This article is protected by copyright. All rights reserved.

http://ift.tt/2qwvmAm

Late-onset Rasmussen Encephalitis: A literature appraisal

Publication date: Available online 29 May 2017
Source:Autoimmunity Reviews
Author(s): Sophie Dupont, Ana Gales, Serge Sammey, Marie Vidailhet, Virginie Lambrecq
Rasmussen Encephalitis (RE) is classically described as a childhood encephalopathy due to a unilateral inflammation of the cerebral cortex with a presumed immune-mediated pathophysiological basis. Unusual variant forms, including adolescent and adult-onset RE have been described but there is still a doubt whether these atypical cases correspond to classical RE patients. To review evidence, a systematic PubMed search was conducted to retrieve papers addressing late onset RE to assess (i) the positivity rate of classical childhood-onset diagnostic criteria for RE in late-onset RE, (ii) the specific clinical and radiological features that could help earlier diagnosis and therapeutic interventions, (iii) the arguments for an autoimmune pathophysiology including (iiia) the association with autoimmune markers or diseases and (iiib) the effects of immunomodulatory or immunosuppressive treatments. A total of 50 papers were considered. We identified 102 late-onset RE patients with a sex ratio of 8 women for 2 men. 67% fulfilled the consensus diagnostic criteria for RE. As compared to classical RE, the late-onset RE patients exhibited: i) more frequent focal complex partial seizures, ii) less frequent epilepsia partialis continua throughout evolution, iii) a slower evolution with a delayed occurrence of cortical deficit, iv) less cognitive deterioration and v) a better outcome. A specific association with autoimmune markers or diseases was not found. Immunomodulatory therapies, even performed in a late stage, improved late-onset RE patients in 61% of cases. This review proves that late-onset RE is a reality with specific clinical and radiological features. The good response to immunomodulatory treatments brings further arguments for an immune-regulated process.



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The role of endothelial cells in the vasculopathy of systemic sclerosis: A systematic review

Publication date: Available online 29 May 2017
Source:Autoimmunity Reviews
Author(s): Y. Mostmans, M. Cutolo, C. Giddelo, S. Decuman, K. Melsens, H. Declercq, E. Vandecasteele, F. De Keyser, O. Distler, J. Gutermuth, V. Smith
IntroductionSystemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by fibroproliferative vasculopathy, immunological abnormalities and progressive fibrosis of multiple organs including the skin. In this study, all English speaking articles concerning the role of endothelial cells (ECs) in SSc vasculopathy and representing biomarkers are systematically reviewed and categorized according to endothelial cell (EC) (dys)function in SSc.MethodsA sensitive search on behalf of the EULAR study group on microcirculation in Rheumatic Diseases was developed in Pubmed, The Cochrane Library and Web of Science to identify articles on SSc vasculopathy and the role of ECs using the following Mesh terms: (systemic sclerosis OR scleroderma) AND pathogenesis AND (endothelial cells OR marker). All selected papers were read and discussed by two independent reviewers. The selection process was based on title, abstract and full text level. Additionally, both reviewers further searched the reference lists of the articles selected for reading on full text level for supplementary papers. These additional articles went through the same selection process.ResultsIn total 193 resulting articles were selected and the identified biomarkers were categorized according to description of EC (dys)function in SSc. The most representing and reliable biomarkers described by the selected articles were adhesion molecules for EC activation, anti-endothelial cell antibodies for EC apoptosis, vascular endothelial growth factor (VEGF), its receptor VEGFR-2 and endostatin for disturbed angiogenesis, endothelial progenitors cells for defective vasculogenesis, endothelin-1 for disturbed vascular tone control, Von Willebrand factor for coagulopathy and interleukin (IL)-33 for EC- immune system communication. Emerging, relatively new discovered biomarkers described in the selected articles, are VEGF165b, IL-17A and the adipocytokines. Finally, myofibroblasts involved in tissue fibrosis in SSc can derive from ECs or epithelial cells through a process known as endothelial-to-mesenchymal transition.ConclusionThis systematic review emphasizes the growing evidence that SSc is primarily a vascular disease where EC dysfunction is present and prominent in different aspects of cell survival (activation and apoptosis), angiogenesis and vasculogenesis and where disturbed interactions between ECs and various other cells contribute to SSc vasculopathy.



http://ift.tt/2s998Wc

Autophagy in neuroinflammatory diseases

Publication date: Available online 29 May 2017
Source:Autoimmunity Reviews
Author(s): Sylviane Muller, Susana Brun, Frédérique René, Jérôme de Sèze, Jean-Philippe Loeffler, Hélène Jeltsch-David
Autophagy is a metabolically-central process that is crucial in diverse areas of cell physiology. It ensures a fair balance between life and death molecular and cellular flows, and any disruption in this vital intracellular pathway can have consequences leading to major diseases such as cancer, metabolic and neurodegenerative disorders, and cardiovascular and pulmonary diseases. Recent pharmacological studies have shown evidence that small molecules and peptides able to activate or inhibit autophagy might be valuable therapeutic agents by down- or up-regulating excessive or defective autophagy, or to modulate normal autophagy to allow other drugs to repair some cell alteration or destroy some cell subsets (e.g. in the case of cancer concurrent treatments). Here, we provide an overview of neuronal autophagy and of its potential implication in some inflammatory diseases of central and peripheral nervous systems. Based on our own studies centred on a peptide called P140 that targets autophagy, we highlight the validity of autophagy processes, and in particular of chaperone-mediated autophagy, as a particularly pertinent pathway for developing novel selective therapeutic approaches for treating some neuronal diseases. Our findings with the P140 peptide support a direct cross-talk between autophagy and certain central and peripheral neuronal diseases. They also illustrate the fact that autophagy alterations are not evenly distributed across all organs and tissues of the same individual, and can evolve in different stages along the disease course.



http://ift.tt/2rzBwnv

Myocarditis in auto-immune or auto-inflammatory diseases

Publication date: Available online 29 May 2017
Source:Autoimmunity Reviews
Author(s): Cloé Comarmond, Patrice Cacoub
Myocarditis is a major cause of heart disease in young patients and a common precursor of heart failure due to dilated cardiomyopathy. Some auto-immune and/or auto-inflammatory diseases may be accompanied by myocarditis, such as sarcoidosis, Behçet's disease, eosinophilic granulomatosis with polyangiitis, myositis, and systemic lupus erythematosus. However, data concerning myocarditis in such auto-immune and/or auto-inflammatory diseases are sparse. New therapeutic strategies should better target the modulation of the immune system, depending on the phase of the disease and the type of underlying auto-immune and/or auto-inflammatory disease.



http://ift.tt/2s9uIdd

News and Announcements

Publication date: Available online 29 May 2017
Source:Journal of Oral and Maxillofacial Surgery





http://ift.tt/2rQeF6X

Sore throat and an ache radiating from the centre of the anterior neck to the both ears and the occiput.Idiopathic Carotidynia,TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome,Vascular Neck Pain,Painful carotid artery,Inflammation of Carotid artery and neck pain,Carotidynia on ultrasound and magnetic resonance imaging,CT findings in a patient with bilateral metachronous carotidyniaContralateral recurrence of carotidynia during steroid therapy,,Carotidynia Possibly due to Localized Vasculitis,

Carotidynia

From Wikipedia, the free encyclopedia

Drawing from Gray's anatomy with blue arrow showing the bifurcation area which is painful in Carotidynia.

Carotidynia is a syndrome characterized by unilateral (one-sided) tenderness of the carotid artery, near the bifurcation. It was first described in 1927 by Temple Fay.^[1] The most common cause of carotidynia may be migraine, and then it is usually self-correcting. Common migraine treatments may help alleviate the carotidynia symptoms. Recent histological evidence has implicated an inflammatory component of carotidynia, but studies are limited.^[2] Carotid arteritis is a much less common cause of carotidynia, but has much more serious consequences. It is a form ofgiant cell arteritis, which is a condition that usually affects arteries in the head. Due to this serious condition possibly causing carotidynia, and the possibility that neck pain is related to some other non-carotidynia and serious condition, the case should be investigated by a medical doctor.^[3]Because carotidynia can be caused by numerous causes, Biousse and Bousser in 1994 recommended the term not be used in the medical literature.^[4] However, recent MRI and ultrasound studies have supported the existence of a differential diagnosis of carotidynia consistent with Fay's characterization.^[5][6]

References

1. Hill and Hastings list this reference as: Fay, Temple (1927) "Atypical neuralgia." Arch Neurol Psychiatry.
2. Upton, P.; Smith, J. G.; Charnock, D. R. (2003). "Histologic confirmation of carotidynia". Otolaryngology - Head and Neck Surgery. 129 (4): 443–444. doi:10.1016/S0194-5998(03)00611-9. PMID 14574303.
3. Hill LM, Hastings G (1994). "Carotidynia: a pain syndrome.". J Fam Pract. 39 (1): 71–5. PMID 8027735.
4. Biousse V, Bousser MG (1994). "The myth of carotidynia.". Neurology. 44 (6): 993–5. doi:10.1212/wnl.44.6.993. PMID 8208434.Available here
5. Lee TC, Swartz R, McEvilly R, Aviv RI, Fox AJ, Perry J, Symons SP. CTA, MR and MRA imaging of carotidynia: case report. Canadian Journal of Neurological Sciences. 2009 May; 36(3):373-375.
6. Kuhn, J.; Harzheim, A.; Horz, R.; Bewermeyer, H. (2006). "MRI and ultrasonographic imaging of a patient with carotidynia". Cephalalgia. 26 (4): 483–485. doi:10.1111/j.1468-2982.2006.01053.x. PMID 16556251.

External links

• Family Practice notebook.com
• Blog assessing whether carotidynia is a valid medical diagnosis.
• Carotidynia condition page on PatientsLikeMe.

Retrieved from "https://en.wikipedia.org/w/index.php?title=Carotidynia&oldid=768647731"

Categories: 

• Symptoms and signs: Circulatory system
• Pain
• Cardiovascular system stubs

• This page was last edited on 5 March 2017, at 00:34.
• Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.

Case Rep Vasc Med. doi: 10.1155/2013/585789

Carotidynia Possibly due to Localized Vasculitis in a Patient with Latent Mycobacterium tuberculosis Infection.

Cassone G1, Colaci M1, Giuggioli D1, Manfredi A1, Sebastiani M1, Ferri C1.

Author information

1Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Medical School, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy.

Abstract

Carotidynia is a syndrome characterized by tenderness of the carotid artery near the bifurcation due to numerous, heterogeneous causes. Here we reported the case of a 31-year-old Moroccan woman with right-sided neck pain and tenderness with irradiation to ipsilateral ear, eye, and occipital region. Clinical symptoms and imaging findings were suggestive of primary variant of carotidynia syndrome. In particular, color-Doppler ultrasonography revealed a concentric wall thickening of the distal common carotid artery, while thoracic magnetic resonance showed localized perivascular enhancement of the soft tissue in the right medial-distal common carotid artery in T1-weighted images, without intraluminal diameter variation. Moreover, careful clinicoserological and imaging investigations (cranial, cervical, and thoracic angiocomputed tomography and magnetic resonance) excluded well-known disorders potentially responsible for carotidynia syndrome. The patient was scarcely responsive to nonsteroidal anti-inflammatory drugs, but clinical symptoms resolved after three months. Of interest, the patient showed latent Mycobacterium tuberculosis infection (positive tuberculosis interferon-gamma release assay; QuantiFERON-TB Gold); this finding suggested a possible triggering role of mycobacterial antigens in the immune-mediated mechanism responsible for localized carotid injury.

PMID: 24363952

J Stroke Cerebrovasc Dis. doi: 10.1016/j.jstrokecerebrovasdis.2012.10.011

Contralateral recurrence of carotidynia during steroid therapy.

Inatomi Y1, Nakajima M2, Yonehara T3, Hirano T4.

Author information

1Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan. Electronic address: y.inatomix@silk.ocn.ne.jp.

2Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan; Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.

3Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.

4Department of Internal Medicine III, Faculty of Medicine, Oita University, Oita, Japan.

Abstract

A 44-year-old woman presented with contralateral recurrence of carotidynia during steroid therapy at 1 month after onset. Carotidynia can present with a multiphasic clinical course and can affect the neck bilaterally. Therefore, patients with carotidynia should be observed even after remission.

Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Carotidynia; arteritis; carotid artery; magnetic resonance imaging; temporal arteritis; ultrasonography

PMID: 23253536

Wien Klin Wochenschr. doi: 10.1007/s00508-014-0633-2

A pain in the throat: a 19-year history of symptoms relating to the carotid artery.

Elkins A1, Barakate M, Henderson J, Grieve S.

Author information

1School of Medicine, The University of New South Wales, Sydney, NSW, Australia.

Abstract

A 38-year-old man presented with a 19-year history of sore throat and an ache radiating from the centre of the anterior neck to the both ears and the occiput. Computed tomography angiography revealed a tortuous submucosal right internal carotid artery, which was causing tonsillar displacement. The diagnosis of carotidynia has a controversial history within the literature and is currently not accepted as a distinct pathological entity by the International Headache Society. In this patient, the clinical and imaging features, in addition to the absence of any other pathology confers support to the diagnosis of carotidynia.

PMID: 25398291 

Clin Imaging. 2015 Mar-Apr;39(2):305-7. doi: 10.1016/j.clinimag.2014.12.001

CT findings in a patient with bilateral metachronous carotidynia.

Young JY1, Hijaz TA2, Karagianis AG2.

Author information

1Northwestern Memorial Hospital, Department of Radiology, Neuroradiology Section, 251 East Huron Street, Chicago, IL, 60611. Electronic address: joseph.y.young@gmail.com.

2Northwestern Memorial Hospital, Department of Radiology, Neuroradiology Section, 251 East Huron Street, Chicago, IL, 60611.

Abstract

Carotidynia is a self-limiting, idiopathic clinical syndrome characterized by acute unilateral neck pain and tenderness of the carotid artery. We describe a unique case of bilateral carotidynia that occurred metachronously, with each incident resolving without long-term sequelae. Knowledge of this entity is important to properly interpret the imaging findings and to not mistake this finding as an ill-defined tumor, thus avoiding unnecessary biopsy.

Copyright © 2015 Elsevier Inc. All rights reserved.KEYWORDS:CT; Carotidynia; inflammation; neck; pain.PMID: 25575581 

J Mal Vasc. 2015 Dec;40(6):395-8. doi: 10.1016/j.jmv.2015.06.001

Comparative evolution of carotidynia on ultrasound and magnetic resonance imaging.

Behar T1, Menjot N2, Laroche JP3, Böge B3, Quéré I3, Galanaud JP3.

Author information

1Clinical investigation center and department of internal medicine, hôpital de Montpellier, university hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France. Electronic address: t-behar@chu-montpellier.fr.

2Department of neuroradiology, university hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.

3Clinical investigation center and department of internal medicine, hôpital de Montpellier, university hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.

Abstract

Carotidynia is rare and associates neck pain with tenderness to palpation usually over the carotid bifurcation, the diagnosis of which is based on magnetic resonance imaging (MRI). Ultrasounds (US) are also frequently used but their accuracy in predicting the course of the disease is unknown. We are reporting the case of a 52-year-old man who presented a typical carotidynia. Clinical symptoms, ultrasound and MRI imaging evolution were closely correlated. Our case suggest that after a first MRI to set a positive diagnosis of carotidynia and exclude differential diagnoses, US which is more widely available and less expensive could constitute the imaging of reference for the follow-up.

Copyright © 2015 Elsevier Masson SAS. All rights reserved.KEYWORDS:Carotidynia; Carotidynie; Follow-up; Imagerie par résonance magnétique; Magnetic resonance imaging; Suivi; Ultrasonography; Échographie.PMID: 26163344

Vasc Endovascular Surg. 2017 Apr;51(3):149-151. doi: 10.1177/1538574417697212.

Idiopathic Carotidynia.

Policha A1, Williams D2, Adelman M1, Veith F1, Cayne NS1.

Author information

1

1 Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY, USA.

2

2 Department of General Surgery, New York University Langone Medical Center, NY, USA.

Abstract

Idiopathic carotidynia is a syndrome characterized by pain and tenderness over the carotid artery without an associated structural luminal abnormality. Controversy exists over whether this is a distinct disease entity or merely a symptom attributable to other causes of neck pain, such as carotid dissection or vasculitis. A 50-year-old woman presented with sudden-onset right neck pain. Imaging studies demonstrated transmural inflammation of the proximal internal carotid artery, without evidence of intraluminal pathology. The patient was placed on low-dose aspirin and ibuprofen. Her symptoms resolved within a week. At 3-month follow-up, her carotid artery appeared normal on duplex ultrasonography.

KEYWORDS:

carotid artery; carotidynia; ultrasound

PMID: 2833043

AJNR Am J Neuroradiol. 2017 May 11. doi: 10.3174/ajnr.A5214

TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity.

Lecler A1, Obadia M2, Savatovsky J2, Picard H2, Charbonneau F2, Menjot de Champfleur N2, Naggara O2, Carsin B2, Amor-Sahli M2, Cottier JP2, Bensoussan J2, Auffray-Calvier E2, Varoquaux A2, De Gaalon S2, Calazel C2, Nasr N2, Volle G2, Jianu DC2, Gout O2, Bonneville F2, Sadik JC2.

Author information

1

From the Departments of Radiology (A.L., J.S., F.C., J.C.S.), and Neurology (M.O., G.V., O.G.), and Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France; Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France; Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France; Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France; Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France; Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France; Diagnostic and Interventional Neuroradiology Department (E.A.-C.) and Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France; Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France; Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France; Departments of Neuroradiology (C.C., F.B.) and Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France; and Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. alecler@for.paris.

2

From the Departments of Radiology (A.L., J.S., F.C., J.C.S.), and Neurology (M.O., G.V., O.G.), and Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France; Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France; Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France; Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France; Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France; Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France; Diagnostic and Interventional Neuroradiology Department (E.A.-C.) and Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France; Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France; Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France; Departments of Neuroradiology (C.C., F.B.) and Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France; and Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.

Abstract

BACKGROUND AND PURPOSE:

The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity.

MATERIALS AND METHODS:

From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets.

RESULTS:

The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others.

CONCLUSIONS:

Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.

© 2017 American Society of Neuroradiology.

PMID: 28495942 DOI: 10.3174/ajnr.A5214

Vascular Neck Pain–A Common Syndrome Seldom Recognized

Cleveland Clinic Journal of Medicine. 

LEONARD L. LOVSHIN, M.D.

Department of Internal Medicine

Abstract

A YOUNG or middle-aged women reported to her physician because of a sore throat, without fever or other constitutional manifestations, which may have been present for weeks or months. The patient believes that the glands in the neck are swollen. These "swollen glands" are said to act strangely: sometimes the swelling lasts only a few hours, sometimes it persists for weeks; it disappears mysteriously and recurs frequently. During the course of the physical examination the physician finds no abnormality, but when he re-examines the neck and follows the directions given by the patient, he finds a tender swelling that could be an inflamed lymph node.

The patient then is treated with a sulfonamide or with penicillin, and, when no relief ensues, a course of one of the broad-spectrum antibiotics is administered. This therapeutic program also is unsuccessful, and the harried physician begins to think of other possibilities. Since the patient has "swollen glands," feels weak, tired, and run-down, and antimicrobial therapy has not helped, a diagnosis of infectious mononucleosis may be considered. But, results of a heterophil antibody test are negative, and the diagnosis is changed to possible viral infection.

After several weeks or months of having diagnoses changed, the nervous patient can sense that her physician is uncertain, and she begins to worry about the looming possibility of cancer. She keeps poking in the region of the soreness, and the area becomes even more tender. In desperation, further investigations are carried out and nothing definitely abnormal is found. Teeth . . .

http://journals.sagepub.com/doi/abs/10.1177/0009922816677040?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

Alexandros Sfakianakis
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6948891480

alsfakia@gmail.com