Heme oxygenase-1 directly binds STAT3 to control the generation of pathogenic Th17 cells during neutrophilic airway inflammation

Abstract

Background

Specific JAK/STAT pathways play a critical role in the functional differentiation of distinct Th subsets. Previously, we showed that HO-1, a stress-inducible protein, inhibits Th17 cell differentiation and alleviates neutrophilic airway inflammation, but the responsible molecular basis remains unclear.

Methods

We employed Th17-skewing differentiation and NEA mouse models to study the role of HO-1 regulating IL-6-STAT3-RORγt/SOCS3 signaling pathway to control Th17 cell-mediated neutrophilic airway inflammation. The levels of cytokines and expressions of relative signaling molecular were measured by ELISA, western blot and qPCR, respectively. Frequency of CD4⁺IL-17A⁺, CD4⁺IL-6R⁺ and CD4⁺IL-23R⁺ cells was analyzed by FCM. The interaction between HO-1 and signaling pathway-related proteins was determined by Co-Immunoprecipitation and western blot.

Results

Here, we show that hemin-induced HO-1 over-expression is required to mediate this process. Specifically, HO-1 decreased STAT3 phosphorylation but not IL-6R/IL-23R expression or JAK1/JAK2 activation in CD4⁺ T cells. The effect was accompanied by co-inhibition of SOCS3, a negative feedback factor of STAT3 activation. HO-1 bound to three domains on STAT3, (DNA-binding, linker and transactivation domains) to directly regulate STAT3 activation. Conversely, either forced expression of a constitutively active STAT3 mutant or application of small interfering RNA (siRNA) for HO-1 reversed these effects.

Conclusions

Our data suggest that HO-1 exerts its inhibitory effect on Th17 cell differentiation by directly associating and blocking STAT3 phosphorylation. We speculate that hemin may be a potential therapeutic candidate for the treatment of other types of immune and pulmonary inflammatory-related diseases.

This article is protected by copyright. All rights reserved.

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Atypical presentation of sigmoid carcinoma

Abstract

Colorectal carcinoma is common worldwide and its metastasis represents the main cause of mortality related to the disease. Inguinal metastization of this tumor has been considered almost impossible, owing to colon anatomy and its cranial lymphatic drainage. We report the case of a 63-year-old man submitted to laparoscopical sigmoid colectomy, due a sigmoid adenocarcinoma. During follow-up, a right inguinal lymphadenopathy with 25 mm was detected. Fine needle aspiration biopsy revealed that it was a colon adenocarcinoma metastasis, and thus the patient underwent an inguinal lymphadenectomy. The histological study confirmed metastatic adenocarcinoma of the colon and the patient was submitted to 5-fluouracil and oxaliplatin chemotherapy. This case coursed with metastasis to the right inguinal region; although, the pathophysiological mechanism involved is difficult to understand. There are no solid data for the management of these patients. Inguinal lymphadenectomy and chemotherapy, proved to be effective.

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Ethmoid malformation associated with pediatric nasal polyposis and allergic fungal sinusitis

Abstract

A 17-year-old female with allergic fungal sinusitis and nasal polyposis presented with epistaxis in the emergency room. On examination, right-sided proptosis and irregular nasal obstruction were observed in the right nasal cavity. CT imaging revealed massive right-sided polyposis and significant ipsilateral malformation with boney architecture preservation of the ethmoidal labyrinth and lamina papyracea. The patient was treated surgically with symptomatic improvement. These findings indicate a unique malformation of the ethmoid while the patient was in development. To the authors' knowledge, this anatomical malformation has not been previously described in the literature. Physicians should implement diagnostic procedures early if nasal polyposis and allergic fungal sinusitis is suspected in pediatric patients, especially with periocular involvement, to mitigate the risk of boney malformations of the sinuses.

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Primary extrahepatic bile duct neuroendocrine tumor with obstructive jaundice masquerading as a Klatskin tumor

Abstract

Neuroendocrine tumors (NETs) of the extrahepatic bile duct are extremely rare and reported infrequently in the literature. These tumors are difficult to diagnose preoperatively, and the prognosis is variable, often determined by extent of disease, tumor grade and resectability. This case report presents a 45-year-old male with history of biliary obstruction relieved by endobiliary stents with common hepatic duct stricture just above the cystic duct, thought to be a Klatskin's cholangiocarcinoma. Final pathological examination was consistent with primary extrahepatic NET.

http://ift.tt/2suDFhz

Laparoscopic harvest of the gastro-omental free flap for reconstruction after total pharyngolaryngectomy: Operative technique

Abstract

Circumferential defects following salvage pharyngolaryngectomy present significant challenges in reconstructive surgery. The gastro-omental free flap has been shown to reduce the incidence of major fistula and catastrophic complications. The current technique for harvest of the flap requires laparotomy, which is potentially associated with significant post-operative complications. Laparoscopic harvest of the gastro-omental free flap can negate some of the risks associated with open surgery. We describe here the operative technique for laparoscopic gastro-omental free flap harvest for use in reconstruction following total pharyngolaryngectomy. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Prognostic value of lymphovascular invasion of the primary tumor in hypopharyngeal carcinoma after total laryngopharyngectomy

Abstract

Background

We aimed to determinate the prognostic value of lymphovascular invasion in the specimens resected during total laryngopharyngectomy for hypopharyngeal carcinoma.

Methods

Patients who underwent total laryngopharyngectomy at our institution between 2004 and 2014 were included in this study and retrospectively analyzed. We then discriminated for vascular invasion and lymphatic invasion of the primary tumor in all cases.

Results

We reviewed 135 records (120 men and 15 women; age range, 36–84 years). Tumors with lymphatic invasion tended to be associated with more metastatic lymph nodes and extracapsular spread (ECS) of metastatic lymph nodes. Tumors with vascular invasion tended to be associated with nonpyriform sinus locations. In a multivariate analysis, nonpyriform sinus locations, >3 metastatic lymph nodes, and vascular invasion remained significant prognostic factors for overall survival (OS); in recursive partitioning analysis, ECS and vascular invasion remained important categorical variables for OS.

Conclusion

Vascular invasion is a strong prognostic biomarker for advanced hypopharyngeal carcinoma. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Multiple single nucleotide polymorphism analysis and association of specific genotypes in FHIT, SAMD4A, and ANKRD17 in Indian patients with oral cancer

Abstract

Background

Oral cancer has a high incidence primarily because of tobacco chewing habits. However, a small proportion of habitués develop oral cancer, implying a role for genomic variants in its susceptibility.

Methods

Thirteen single nucleotide polymorphisms (SNPs) in an Indian cohort comprising patients with oral cancer (n = 500) and healthy controls (n = 500) were genotyped using allelic discrimination real-time polymerase chain reaction (PCR).

Results

Prevalence of SNPs rs11130760, rs1957358, rs2306058, rs4883543, rs12637722, rs1457115, rs2353292, rs709821, rs2194861, rs4789378, rs3827538, rs2667552, and rs2886093 was determined in the Indian cohort. A significant association of rs11130760 GG (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.08-1.84) and rs1957358 TT (OR 1.44; 95% CI 1.10-1.90) indicated increased risk; whereas rs1957358 TC (OR 0.67; 95% CI 0.53-0.87) and rs2306058 CT (OR 0.72; 95% CI 0.56-0.93) reflected decreased risk. The SNP rs11130760 wild-type (WT) allele G indicated an increased risk for oral cancer (OR 1.38; 95% CI 1.09-1.73), whereas SNP allele T indicated a decreased risk (OR 0.73; 95% CI 0.58-0.92) for oral cancer.

Conclusion

Our study identified SNPs with susceptibility to oral cancer in high-risk populations.

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Functional outcomes of fasciocutaneous free flap and pectoralis major flap for salvage total laryngectomy

Abstract

Background

Pectoralis major muscle flaps (PMMFs) and fasciocutaneous free flaps (FFFs) are commonly used for reconstruction of the surgical defect after salvage total laryngectomy. This study compared swallowing function in patients who underwent reconstruction with either PMMF or FFF.

Methods

This study was based on a retrospective cohort of patients treated at the CHU de Québec between January 2000 and March 2015. Demographics, chemoradiation data, surgical protocol, pathologic results, complications, evolution, esophageal dilation, diet intake, and feeding tube dependence were documented.

Results

A total of 126 patients were analyzed (93 PMMFs and 33 FFFs). Of the patients who received PMMFs, 38.7% had a limited oral intake compared to 15.2% of patients who received FFFs (odds ratio [OR] 3.54; 95% confidence interval [CI] 1.25-9.99; P = .02). The need for esophageal dilation tended to be greater for PMMF patients (25% vs 9%; OR 3.38; 95% CI 0.94-12.13; P = .06). Complication rates were similar.

Conclusion

The FFF reconstruction led to better results in terms of swallowing function than PMMF reconstruction.

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AHNS Series – Do you know your guidelines? Lip cancer

Abstract

Background

Lip cancer is one of the most curable primary head and neck malignancies, as the prominent location typically lends to an early diagnosis. The incidence of lip cancer varies by sex, ethnicity, and region, but is estimated to be up to 2.5/100 000 in the United States (squamous cell carcinoma [SCC]).

Methods

This article will review the current literature and National Comprehensive Cancer Network practice guidelines in the treatment of lip cancer.

Results

Resection of lip cancer with negative margins remains the mainstay of therapy. Positive nodal disease should be treated with neck dissection and adjuvant radiotherapy.

Conclusion

Lip cancer remains highly curable when diagnosed at an early stage. A multidisciplinary approach is crucial to treating patients with advanced-stage lip cancer.

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Morphologic and topographic radiologic features of human papillomavirus–related and unrelated oropharyngeal carcinoma

Abstract

Background

The purpose of this study was to compare the clinicoradiologic characteristics of human papillomavirus (HPV)-related (HPV-positive) and HPV-unrelated (HPV-negative) oropharyngeal carcinoma (OPC).

Methods

Primary tumor and lymph node features of HPV-positive and HPV-negative OPCs from 2008 to 2013 were compared on pretreatment CT/MRI. Intrarater/interrater concordance was assessed. Multivariable analyses identified factors associated with HPV-positivity to be used in nomogram construction.

Results

Compared to HPV-negative (n = 194), HPV-positive (n = 488) tumors were more exophytic (73% vs 63%; p = .02) with well-defined border (58% vs 47%; p = .033) and smaller axial dimensions; lymph node involvement predominated (89% vs 69%; p < .001) with cystic appearance (45% vs 32%; p = .009) but similar topography. Intrarater/interrater concordance varied (fair to excellent). Nomograms combining clinical (age, sex, smoking pack-years, subsite, T/N classification) and/or radiologic (nonnecrotic tumor and cystic lymph node) features were used to weigh the likelihood of HPV-driven tumors (area under the curve [AUC] = 0.84).

Conclusion

HPV-positive OPC has different radiologic tumor (exophytic/well-defined border/smaller axial dimension) and lymph node (cystic) features but similar lymph node topography.

http://ift.tt/2qWpzn6

Issue Information

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Issue Information

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Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis

Abstract

We performed this meta-analysis to investigate the efficacy of low-level laser therapy (LLLT), a physiotherapy modality with anti-inflammatory and analgesic effects, in the management of mild-to-moderate carpal tunnel syndrome (CTS). We searched PubMed, Web of Knowledge, Scopus, Cochrane Central, and Virtual Health Library for randomized controlled trials (RCTs) that compared the effects of LLLT with or without splinting versus placebo on functional and electromyographic outcomes in CTS. All outcomes were pooled as mean differences (MD) under the inverse variance or random effects model, using the statistical add-in (MetaXL, version 5.0). Eight RCTs (473 patients/631 wrists) were eligible for the final analysis. The overall effect estimates did not favor LLLT therapy group over placebo in all primary outcomes: visual analogue scale (MD −1.11, 95% CI [−2.58, 0.35]), symptom severity scale score (MD −1.41, 95% CI [−5.12, 2.29]), and functional status scale score (MD −1.33, 95% CI [−3.27, 0.61]). However, LLLT was superior to placebo in terms of grip strength (MD 2.19, 95% CI [1.63, 2.76]) and inferior to placebo in terms of sensory nerve action potential (MD −2.74, 95% CI [−3.66, −1.82]). Laser therapy is superior to placebo in terms of improving the grip strength; however, no significant difference was found between both groups in terms of functional status improvement, pain reduction, or motor electrodiagnostic evaluations. Further high-quality trials with longer follow-up periods are required to establish the efficacy of LLLT for CTS treatment.

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Oral Complications of Dermatologic Disorders

Publication date: Available online 3 June 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Paolo G. Arduino




http://ift.tt/2qR0qz7

Programmable cells of monocytic origin as a source of osteochondroprogenitors: Effect of growth factors on osteogenic differentiation

We have demonstrated previously that peripheral blood monocytes can be converted in vitro to a multipotent stem cell−like cell termed programmable cell of monocytic origin (PCMO) and subsequently into cells with chondrocyte-like phenotype. Here, we investigated whether PCMO could also be differentiated into osteoblast-like cells using growth factors with known osteoinductive potency. Following stimulation with BMP-2, BMP-7, IGF-1 or TGF-β1 for 7 and 14 days, PCMOs were analysed for mRNA expression of collagen types I and V, alkaline phosphatase, osteocalcin, runt-related transcription factor-2 (Runx2) and Osterix (Osx) by quantitative RT-PCR (qPCR) and the levels of collagen I in culture supernatants by ELISA.

http://ift.tt/2qQsUJo

The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting—a retrospective study in 31 patients

To evaluate the impact of glucocorticosteroids, administered for the treatment of systemic diseases, on the osseointegration and survival of dental implants placed without bone grafting.

http://ift.tt/2rzPzXe

The impact of surgical intervention and antibiotics on MRONJ stage II and III – retrospective study

Metastatic bone disease and osteoporosis are the main indications for bisphosphonates and anti-resorptive agent therapy. Inhibition of bone turnover and angiogenesis are mainly responsible for the development of Medication Related Osteonecrosis of Jaws (MRONJ) as therapeutic side-effect. Yet, the role of infection for the development and recurrence of MRONJ is not fully elucidated. The aim of this retrospective study is to explore if a difference in antibiotic regimes has an impact on the surgical intervention needed to achieve a painless stable stage of the disease.

http://ift.tt/2qQCBqV

Long-term survival of a randomized phase III trial of head and neck cancer patients receiving concurrent chemoradiation therapy with or without low-level laser therapy (LLLT) to prevent oral mucositis

Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Héliton S. Antunes, Daniel Herchenhorn, Isabele A. Small, Carlos M.M. Araújo, Celia Maria Pais Viégas, Gabriela de Assis Ramos, Fernando L. Dias, Carlos G. Ferreira
BackgroundThe impact of low-level laser therapy (LLLT) to prevent oral mucositis in patients treated with exclusive chemoradiation therapy remains unknown. This study evaluated the overall, disease-free and progression-free survival of these patients. Methods: Overall, disease-free and progression-free survival of 94 patients diagnosed with oropharynx, nasopharynx, and hypopharynx cancer, who participated on a phase III study, was evaluated from 2007 to 2015. The patients were subjected to conventional radiotherapy plus cisplatin every 3weeks. LLLT was applied with an InGaAlP diode (660nm–100mW–1J–4J/cm²).ResultsWith a median follow-up of 41.3months (range 0.7–101.9), patients receiving LLLT had a statistically significant better complete response to treatment than those in the placebo group (LG=89.1%; PG=67.4%; p=0.013). Patients subjected to LLLT also displayed increase in progression-free survival than those in the placebo group (61.7% vs. 40.4%; p=0.030; HR:1:93; CI 95%: 1.07–3.5) and had a tendency for better overall survival (57.4% vs. 40.4%; p=0.90; HR:1.64; CI 95%: 0.92–2.91).ConclusionThis is the first study to suggest that LLLT may improve survival of head and neck cancer patients treated with chemoradiotherapy. Further studies, with a larger sample, are necessary to confirm our findings.



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Prognostic role of tumor infiltrating lymphocytes in EBV positive and EBV negative nasopharyngeal carcinoma

Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Marc L. Ooft, Jolique A. van Ipenburg, Weibel W. Braunius, Charlotte I. Zuur, Senada Koljenović, Stefan M. Willems
ObjectivesTumor infiltrating lymphocytes (TILs) correlate with both better and worse prognosis in solid tumors. As therapeutic modalities for nasopharyngeal carcinoma (NPC) are limited, immunotherapy could be a potential alternative. Up till now there is limited prognostic data on the role of TILs in NPC, so we assessed the prognostic role of TILs in Epstein-Barr-virus (EBV) positive and negative NPC.MethodsTissue of 92 NPCs was assessed for CD3, CD4, CD8, PD1 and PDL1 expression in the tumor's micro-environment. Correlations between clinicopathological characteristics was assessed using the Pearson X² test, Fisher's exact test and ANOVA. Survival was analyzed with the Kaplan-Meier method and Cox regression. Differences in CD3, CD4, CD8, PD1, PDL1 counts/(co)expression between EBV positive and negative NPCs were evaluated using the Mann-Whitney U test. Two-tailed P values below 0.05 were considered statistically significant.ResultsEBV positive NPC contains significantly more CD3, CD4 and CD8 TILs than EBV negative NPC. In the whole NPC group, increased CD8 count is associated with better overall survival (OS) (HR 0.219 (95%CI 0.075–0.640)), but also in cases with PDL1 co-expression (HR 0.073 (95%CI 0.010–0.556)). In EBV positive NPC co-expression of CD8 and PDL1 showed better disease free survival (HR 0.407 (95%CI 0.195–0.850)) and OS (HR 0.170 (95%CI 0.037–0.787)).ConclusionsAlthough TILs are significantly different between EBV positive and negative NPCs, it is especially composition of the infiltrate which determines prognosis. Effects of PD1 and CD8 need more study, because these findings show much potential in using immunotherapeutic modalities in NPC treatment.



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A network meta-analysis of the sequencing and types of systemic therapies with definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LASCCHN)☆

Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Katarzyna J. Jerzak, Keemo Delos Santos, Ronak Saluja, Kelly Lien, Justin Lee, Kelvin K.W. Chan
ObjectivesThe current standard therapy for locally advanced squamous cell carcinoma of the head and neck (LASCCHN) is platinum-based chemotherapy plus concurrent radiotherapy (CRT), but several systemic therapies have been evaluated. We performed a Bayesian network meta-analysis (NMA) with random effects to enable direct and indirect comparisons of all existing treatment modalities for LASCCHN simultaneously.Material and methodsA systematic review was conducted using MEDLINE, EMBASE, ASCO abstracts, ASTRO abstracts and the Cochrane Central of Registered Trials using Cochrane methodology to identify randomized controlled trials (RCTs) up to June 2016. Only abstracts that involved the same definitive radiotherapy in the arms for the RCT were included.ResultsSixty-five RCTs involving 13,574 patients and 16 different treatment strategies were identified. Chemotherapy plus concurrent radiation (CRT) was superior to RT with a HR of 0.74 (95%CR 0.69–0.79) for OS in the NMA. Only 3 trials compared RT alone to concurrent therapy with an EGFR antibody (ERT), demonstrating a superior OS (HR 0.75, 95% CR 0.60–0.94), but this difference was not statistically significant when interpreted in a NMA (HR 0.84, 95%CR 0.65–1.08). ERT was not superior to CRT (HR 1.19, 95%CR 0.93–1.54), and the addition of neo-adjuvant taxane-based chemotherapy to CRT was not beneficial (HR 0.86, 95% CR 0.70–1.07).ConclusionThe addition of either adjuvant or neoadjuvant chemotherapy to the CRT backbone does not confer an OS benefit in the treatment of LASCCHN. Similarly, ERT does not confer an OS benefit for patients who are eligible for CRT.



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Device to stablise nasoendotracheal tube during intraoral or orthognathic surgery

Publication date: Available online 3 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S.-H. Kang, S.-H. Lee




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The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting—a retrospective study in 31 patients

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Vassileios Petsinis, Georgios Kamperos, Foteini Alexandridi, Konstantinos Alexandridis
PurposeTo evaluate the impact of glucocorticosteroids, administered for the treatment of systemic diseases, on the osseointegration and survival of dental implants placed without bone grafting.Materials and MethodsA retrospective study was conducted in search of patients treated with dental implants while receiving glucocorticosteroid therapy for various systemic diseases. In these cases, a conventional two-stage surgical protocol was used, without bone regeneration procedures. The osseointegration was clinically and radiographically tested at the uncovering of the implants. The follow-up after loading was set at a minimum of 3 years.ResultsA total of 31 patients were included in the study. Of the 105 dental implants placed, 104 were osseointegrated (99%). No bone absorption was radiographically noted at the uncovering of the osseointegrated implants. All of the osseointegrated implants were successfully loaded for the prosthetic restoration. The mean follow-up period after loading was 71 months, with an implant survival rate of 99%.ConclusionsGlucocorticosteroid intake for systemic diseases does not have a significant impact on the osseointegration and the 3-year survival of dental implants placed with a conventional two-stage surgical protocol and without bone grafting. Therefore, it should not be considered a contraindication for dental implant placement.



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Programmable cells of monocytic origin as a source of osteochondroprogenitors: Effect of growth factors on osteogenic differentiation

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yahya Açil, Björn Möller, Jörg Wiltfang, Fred Fändrich, Hendrik Ungefroren
We have demonstrated previously that peripheral blood monocytes can be converted in vitro to a multipotent stem cell−like cell termed programmable cell of monocytic origin (PCMO) and subsequently into cells with chondrocyte-like phenotype. Here, we investigated whether PCMO could also be differentiated into osteoblast-like cells using growth factors with known osteoinductive potency. Following stimulation with BMP-2, BMP-7, IGF-1 or TGF-β1 for 7 and 14 days, PCMOs were analysed for mRNA expression of collagen types I and V, alkaline phosphatase, osteocalcin, runt-related transcription factor-2 (Runx2) and Osterix (Osx) by quantitative RT-PCR (qPCR) and the levels of collagen I in culture supernatants by ELISA. The expression of osteoblastic markers was evident, albeit at a different extent in cultures of PCMOs after treatment with the above-mentioned growth factors. Culture supernatants from PCMOs stimulated for 6-10 days with BMP-2, BMP-7, IGF-1 or TGF-β1 contained high levels of collagen type I, together with earlier data indicating synthesis and proper secretion. The findings suggest that PCMOs can transform into cells that are phenotypically similar to osteoblasts and identify these cells as osteochondroprogenitors. The possibility of differentiating PCMOs from peripheral blood in sizable quantities could be a novel way to obtain autologous bone-like substitutes without donor-site morbidity.



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Fluorescence based characterization of early oral squamous cell carcinoma using the Visually Enhanced Light Scope technique

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Egon Burian, Caterina Schulz, Florian Probst, Benjamin Palla, Matthias Tröltzsch, Fabio Maglitto, Luigi Califano, Michael Ehrenfeld, Sven Otto
ObjectivesSeveral diagnostic tools have been developed to assess benign and potentially malignant disorders of soft tissues. In this study, we aimed to assess the value of the VELscope^® (Visually Enhanced Light Scope) imaging device as a technical tool to investigate malignant lesions of the oral cavity.Material and methodsIn this retrospective study we analyzed the photographs of 90 patients who suffered from malignant oral soft tissue lesions or carcinoma in situ (CIS) from 2008 to 2014 in the Clinic of Oral and Maxillofacial Surgery of LMU in Munich.ResultsIn 85.6% of the cases fluorescence quenching/loss could be detected. The average value for the colour red shows a significant difference in pathologic and physiologic tissues (p=0.007) with a higher median for pathologic tissues. For the colours green and blue our measurements show significantly higher values in the healthy tissue (p< 0.001.). The shade of red showed significantly higher values for pathologic tissues when compared to all three colours (p< 0.001). Furthermore, the shades of green and blue showed significantly lower values in the pathologic tissue (p< 0.001).ConclusionIn the near future, VELscope^® could help to a greater extent than visual observation alone in identifying the margins of tumor resections. VELscope^® still lacks the ability to identify the overall risk level of oral lesions.



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The influence of different abutment materials on tissue regeneration after surgical treatment of peri-implantitis - a randomized controlled preclinical study

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Tobias Moest, Jan Wrede, Christian Martin Schmitt, Melanie Stamp, Friedrich Wilhelm Neukam, Karl Aandreas Schlegel
ObjectivesThis study aimed to assess the impact of different abutment materials on peri-implant tissue regeneration after surgical treatment of peri-implantitis in a large animal model.Material and MethodsTitanium implants (n = 51) were inserted in the upper and lower jaw of eight beagle dogs and a peri-implant infection was induced. After two months the peri-implant infection was surgically treated and abutments with different surfaces (Ti-2: n = 14; CoCrMb: n = 13; Ag-modified Ti-4: n =14; Ti-4 control: n = 10) were applied. Clinical attachment level (CAL), modified sulcus bleeding index (mBI), bleeding on probing (BoP), and the sulcus fluid flow rate (SFFR) were determined 4, 8, and 12 weeks after surgical treatment to document the peri-implant tissue reaction.ResultsSuperior levels for CAL and mBI were found with the Ti-4 control and the Ag-modified abutments, with the Ag-modified abutments showing the best values after 12 weeks. Lowest SFFR values compared with the other treatment groups underlined the superior soft tissue reaction adjacent to Ag-modified abutments. After 12 weeks inferior CAL, SFFR, BOP and mBI values were documented for the Ti-2 surface.ConclusionWithin limitations of the study, Ag-modified abutments lead to superior tissue reactions. Further studies are needed to investigate the properties of abutment materials.



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Synchrotron radiation μCT and histology evaluation of bone-to-implant contact

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Camilla Albeck Neldam, Jon Sporring, Alexander Rack, Torsten Lauridsen, Ellen-Margrethe Hauge, Henrik L. Jørgensen, Niklas Rye Jørgensen, Robert Feidenhansl, Else Marie Pinholt




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The impact of surgical intervention and antibiotics on MRONJ stage II and III – retrospective study

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Matthias Zirk, Matthias Kreppel, Johannes Buller, Julij Pristup, Franziska Peters, Timo Dreiseidler, Max Zinser, Joachim E. Zöller
ObjectivesMetastatic bone disease and osteoporosis are the main indications for bisphosphonates and anti-resorptive agent therapy. Inhibition of bone turnover and angiogenesis are mainly responsible for the development of Medication Related Osteonecrosis of Jaws (MRONJ) as therapeutic side-effect. Yet, the role of infection for the development and recurrence of MRONJ is not fully elucidated. The aim of this retrospective study is to explore if a difference in antibiotic regimes has an impact on the surgical intervention needed to achieve a painless stable stage of the disease. Furthermore, we investigated concomitant submucosal infections in local relation to the MRONJ site.MethodsA retrospective study (2006-2015) of 143 patients treated with MRONJ stage II and stage III in a single institutional university hospital was performed. All patients experienced at least one surgical intervention and received antibiotics. Their medical records, pathological and microbial findings were reviewed. Data was controlled for the achievement of an event free time period of at least 12 months.ResultsWe investigated the number and kind of treatments that were performed on patients with MRONJ stage II and III to achieve a painless stable stage of the disease. The first and second healing approach differed significantly from each other (p<0.05). In 7 (4.9%) cases up to four surgical interventions were needed to achieve oral rehabilitation. In 135 (95.1 %) of all cases a segmental resection could be prevented, with extended decortication being the most applied method. Patients under perioperative ampicillin/sulbactam showed a significant reduction for a second or fourth intervention compared to the clindamycin group (p<0.05). Results for a third intervention presented a similar difference between both groups, but were not significant (p= 0.06). Intraoperatively in 76 out of 241 (31.5%) cases presented putrid submucosal infections. The isolated bacteria were gram-negative facultative anaerobes (39.1%) and strictly anaerobic bacteria (gram-positive/38.2%, gram-negative/19.1%). Susceptibly of the cultured bacteria were significantly (p<0.05) in favor to ampicillin/sulbactam (79.1%) compared to clindamycin (49.5%).ConclusionThe perioperative antibiotic regime for patients with MRONJ stage II and III undergoing surgically treatment does have an influence on the recurrence of the disease. Further investigation is needed to elucidate the role of infection in the treatment of MRONJ.



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What is the effect of Anti-resorptive drugs (ARDs) on the development of Medication-Related Osteonecrosis of the jaw (MRONJ) in Osteoporosis Patients: A Systematic Review

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Suad Aljohani, Riham Fliefel, Jacob Ihbe, Jan Kühnisch, Michael Ehrenfeld, Sven Otto
PurposeTo conduct a systematic review of the literature to detect the effect of anti-resorptive drugs (ARDs) and their administration characteristics in the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients.MethodsSystematic search in PubMed, Web of Sciences and Cochrane Library was performed for relevant studies to July 2016. Population variables (age, gender, comorbidities, medications, preceding events, number of patients with MRONJ), ARDs and clinical variables were abstracted independently from these articles.ResultsThe 44 eligible studies described 680 MRONJ cases in osteoporotic patients. The mean age of MRONJ patients was 69.7±5.2 years. It was more common in females. Mandible was the most common site. Alendronate was the most frequently administered ARD. Oral route of administration was noted in 86.7% of the patients. The mean duration of BPs intake was 50.4±19 months. Extraction was the most frequently preceding event followed by dentoalveolar surgery. Corticosteroids or immunosuppressants were the most common concomitant medications in MRONJ.ConclusionA long duration of ARDs administration seems to be an important risk factor in MRONJ development. Patients under treatment with corticosteroids or immunosuppressants might be at a higher risk even if the BPs duration is less than 4 years.



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Analyzing the teeth next to the alveolar cleft: Examination and treatment proposal prior to bone grafting based on three-dimensional versus two-dimensional diagnosis—a diagnostic study

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Susanne Wriedt, Bilal Al-Nawas, Irene Schmidtmann, Sami Eletr, Heinrich Wehrbein, Maximilian Moergel, Collin Jacobs
PurposeThe objective was to evaluate the diagnostic and prognostic value of three-dimensional (3D) cone beam computed tomography (CBCT) on information about the cleft and alignment of cleft neighboring teeth.Materials and MethodsPanoramic X-rays, small-volume CBCTs, and study casts of 20 patients with a total of 22 alveolar clefts were analyzed prior to secondary bone grafting. Six maxillofacial surgeons and 6 orthodontists rated the following parameters: visibility of alveolar cleft expansion, position and probability of alignment of cleft neighbored teeth. Two-dimensional (2D) X-rays and casts were rated first; CBCT and casts followed at least 4 weeks later. Radiologic bone height in the region of the former alveolar cleft, as well as alignment and reasons for nonalignment of cleft neighbored teeth, were recorded 4 years later.ResultsThe rate of proper proposals regarding the real treatment outcome using 2D- or 3D-material did not differ statistically. Although 5%-45% of the proposals were changed when using 3D instead of 2D records, Fleiss multirater kappas showed no essential differences. Raters' profession and experience had no influence on the rate of correct proposals.ConclusionIn orthodontics, small-volume CBCT may be justified only as supplement to a routine panoramic X-ray, and only in selected cases or for surgical preparation.



http://ift.tt/2rq16tQ

Expression of Notch signaling pathway during osteoarthritis in the temporomandibular joint

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Lingli Lan, Yangmei Jiang, Weina Zhang, Ting Li, Binbin Ying, Songsong Zhu
PurposeOur study aim was to characterize the expression of Notch molecules during temporomandibular joint osteoarthritis (TMJOA), thus exploring the mechanism and roles that Notch signaling possibly plays in the initiation and progression of TMJOA.Materials and MethodsA total of 126 mice were divided randomly into experimental groups, a sham-surgery group and a normal control group. In the experimental group, total discectomy was performed in the right temporomandibular joint (TMJ) to induce TMJOA; the sham-operation group underwent the same procedure without disc removal, and the normal control group was left undisturbed. Fourteen mice in each group were sacrificed in batches respectively at 1, 2, and 4 weeks postoperatively. Histology was performed to examine TMJOA in eight condyles each group, and a modified Mankin scoring system was used for evaluation. Immunohistochemistry was carried out to characterize the expression of the Notch markers Notch1, Jagged1, Hes1, and Hes5. Real-time polymerase chain reaction (RT-PCR) was performed for further detection and analysis of Notch markers in six condyles in each group.ResultsNotch1, Jagged1, and Hes5 were activated in the experimental group, with expression levels that increased dramatically over time, whereas the control group showed no fluctuation. Hes1 expression was suppressed at the beginning but was up-regulated afterward.ConclusionsOur data suggest that Notch signaling is activated in TMJOA with a much more abundant expression in osteoarthritis cartilage.



http://ift.tt/2rq1Qzb

Unusual presentation of right coronary artery fistula

Ahmed MSEK Abdelaty<br />May 12, 2017; 2017:bcr-2017-220424-bcr-2017-220424<br />other

http://ift.tt/2qUPzPE

Anisakiasis: a growing cause of abdominal pain!

Joana Carmo<br />May 11, 2017; 2017:bcr2016218857-bcr2016218857<br />case-report

http://ift.tt/2rq2UDj

Long-term stabilisation of myeloma with curcumin

Abbas Zaidi<br />Apr 16, 2017; 2017:bcr2016218148-bcr2016218148<br />case-report

http://ift.tt/2qUKQ0z

Kinesiology taping as an adjunct for pain management in cancer?

Gourav Banerjee<br />Jul 14, 2016; 2016:bcr2016216439-bcr2016216439<br />case-report

http://ift.tt/2rTkCAo

Locally advanced adenocarcinoma of the rectum presenting with necrotising fasciitis of the perineum: successful management with early aggressive surgery and multimodal therapy

Luís Ferreira
Dec 16, 2015; 2015:bcr2015213245-bcr2015213245
case-report

http://ift.tt/2st1hmS

Surviving stroke in an Ebola Treatment Centre

Paul Dhillon<br />Oct 29, 2015; 2015:bcr2015211062-bcr2015211062<br />case-report

http://ift.tt/2rTbImx

Open removal of a retained retrohepatic inferior vena cava filter with a residual primary neuroectodermal renal tumoral thrombus

Carlos A Hinojosa<br />Oct 29, 2015; 2015:bcr2015212190-bcr2015212190<br />case-report

http://ift.tt/2ssvWAF

Freeman-Sheldon syndrome in a 29-year-old woman presenting with rare and previously undescribed features

Robert L Chamberlain<br />Oct 22, 2015; 2015:bcr2015212607-bcr2015212607<br />case-report

http://ift.tt/2rTkAbK

Serotonin syndrome in a breast-fed neonate

Rachel Morris<br />May 6, 2015; 2015:bcr2015209418-bcr2015209418<br />case-report

http://ift.tt/2sspiKL

Takotsubo cardiomyopathy case series: typical, atypical and recurrence

Jakub Lagan<br />Mar 5, 2015; 2015:bcr2014208741-bcr2014208741<br />case-report

http://ift.tt/2rTx6Io

Three-dimensional spectral domain optical coherence tomography in vitreomacular traction

Sandeep Saxena<br />Jun 17, 2014; 2014:bcr2013202065-bcr2013202065<br />case-report

http://ift.tt/2ssv5zM

Primary gut aspergillosis in a patient with acute myeloid leukaemia: the importance of early suspicion and definitive treatment

Elizabeth Li<br />Mar 18, 2014; 2014:bcr2013202316-bcr2013202316<br />case-report

http://ift.tt/2rTdFze

Two rare manifestations of Q fever: splenic and hepatic abscesses and cerebral venous thrombosis, with literature review ma non troppo

Manuel Mendes Gomes<br />Feb 5, 2014; 2014:bcr2013202843-bcr2013202843<br />case-report

http://ift.tt/2ssHdRi

Lemierre syndrome: more than just a sore throat

Christine Azzopardi<br />Nov 28, 2013; 2013:bcr2013201868-bcr2013201868<br />case-report

http://ift.tt/2rTlaGl

Postcaesarean open-heart surgery for Streptococcus sanguinis infective endocarditis

Kiattisak Kongwattanakul<br />Nov 14, 2013; 2013:bcr2013010103-bcr2013010103<br />case-report

http://ift.tt/2sskepz

Partial priapism

Peter Hoyerup<br />Aug 9, 2013; 2013:bcr2013200031-bcr2013200031<br />case-report

http://ift.tt/2rTbf3U

Complication of etanercept treatment for rheumatoid arthritis - purulent pericarditis caused by a commensal organism

Gemma K Taylor<br />May 8, 2012; 2012:bcr0120125644-bcr0120125644<br />case-report

http://ift.tt/2ssGYWu

Editorial Board/Reviewing Committee

Publication date: July 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 7





http://ift.tt/2s6M5hU

Pluripotent stem cell models of Blau syndrome reveal an IFN-γ–dependent inflammatory response in macrophages

Publication date: Available online 3 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sanami Takada, Naotomo Kambe, Yuri Kawasaki, Akira Niwa, Fumiko Honda-Ozaki, Kazuki Kobayashi, Mitsujiro Osawa, Ayako Nagahashi, Katsunori Semi, Akitsu Hotta, Isao Asaka, Yasuhiro Yamada, Ryuta Nishikomori, Toshio Heike, Hiroyuki Matsue, Tatsutoshi Nakahata, Megumu K. Saito
BackgroundBlau syndrome, or early-onset sarcoidosis, is a juvenile-onset systemic granulomatosis associated with a mutation in nucleotide-binding oligomerization domain 2 (NOD2). The underlying mechanisms of Blau syndrome leading to autoinflammation are still unclear, and there is currently no effective specific treatment for Blau syndrome.ObjectivesTo elucidate the mechanisms of autoinflammation in patients with Blau syndrome, we sought to clarify the relation between disease-associated mutant NOD2 and the inflammatory response in human samples.MethodsBlau syndrome–specific induced pluripotent stem cell (iPSC) lines were established. The disease-associated NOD2 mutation of iPSCs was corrected by using a CRISPR-Cas9 system to precisely evaluate the in vitro phenotype of iPSC-derived cells. We also introduced the same NOD2 mutation into a control iPSC line. These isogenic iPSCs were then differentiated into monocytic cell lineages, and the statuses of nuclear factor κB pathway and proinflammatory cytokine secretion were investigated.ResultsIFN-γ acted as a priming signal through upregulation of NOD2. In iPSC-derived macrophages with mutant NOD2, IFN-γ treatment induced ligand-independent nuclear factor κB activation and proinflammatory cytokine production. RNA sequencing analysis revealed distinct transcriptional profiles of mutant macrophages both before and after IFN-γ treatment. Patient-derived macrophages demonstrated a similar IFN-γ–dependent inflammatory response.ConclusionsOur data support the significance of ligand-independent autoinflammation in the pathophysiology of Blau syndrome. Our comprehensive isogenic disease-specific iPSC panel provides a useful platform for probing therapeutic and diagnostic clues for the treatment of patients with Blau syndrome.

Graphical abstract

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