1H022H013J02
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Πέμπτη 8 Ιουνίου 2017
Dermoscopic images of malignant and benign skin lesions
http://sfaki.blogspot.com/2017/06/using-watson-to-diagnose-skin-cancer.htmlAlexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Tilt-induced cardio-inhibitory reflex syncope (BIOSync trial) : 12-item questionnaire to distinguish between complete transient loss of consciousness (i.e., syncope) and pre-syncope or other minor symptoms and, additionally, to provide a standardized categorical description of the clinical presentation of syncope including duration, reproducibility with previous episodes, presence of prodromes, presence of witnesses, context, and consequences of the episode.
http://sfaki.blogspot.com/2017/06/12-item-questionnaire-to-distinguish.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Hypothyreose nach Hemithyreoidektomie − überraschend häufige Komplikation während der Nachsorge
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110856
Hintergrund Hemithyreoidektomie ist eine häufige Behandlung einseitiger Schilddrüsenknoten. Postoperative Hypothyreose ist eine häufig unterschätzte Komplikation. Wir untersuchten Inzidenz, Zeitpunkt, Symptomatik sowie mögliche Risikofaktoren der postoperativen Hypothyreose. Material und Methoden 127 Patienten nach Hemithyreoidektomie wurden mit retrospektiver Datenanalyse sowie strukturierter Befragung der nachbetreuenden Hausärzte und Endokrinologen untersucht. Patienten wurden mit dem postoperativen TSH als hypothyreot (> 4.0 mU/L) oder euthyreot (0.4–4.0 mU/L) klassifiziert. Schilddrüsenhormone wurden nach 4–6 Wochen, 6 Monaten und 1 Jahr gemessen. Ergebnisse 55 Patienten (43 %) entwickelten eine postoperative Hypothyreose und 72 (57%) blieben euthyreot. Die Hypothyreose zeigte sich innerhalb der ersten 2 Monaten bei 39 Patienten (71 %), zwischen 2–6 Monaten bei 13 Patienten (24 %) sowie nach 6–12 Monaten bei 3 Patienten (5 %). 33 Patienten (60 %) waren zum Zeitpunkt der Diagnose asymptomatisch. Nur 16 Patienten (29 %) hatten Symptome. Der präoperative TSH Wert war signifikant höher in der Gruppe der hypothyreoten Patienten (1.64), verglichen mit der euthyreoten Gruppe (1.13, P = 0.0017). Die anderen Variablen wie Alter, Geschlecht und präoperativen Werte von T3, T4, Calcium und PTH zeigten keinen signifikanten Unterschied. Schlussfolgerung Die postoperative Hypothyreose ist eine häufige Komplikation nach Hemithyreoidektomie, welche nicht verpasst werden sollte. Präoperativ erhöhter TSH Wert ist ein Risikofaktor für die postoperative Hypothyreose. Alle Patienten nach Hemithyreoidektomie sollten postoperative TSH Kontrollen nach 4–6 Wochen, 6 Monaten und 12 Monaten haben.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2rHqgnO
Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable?
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603453
The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t-test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B (p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B (p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Multi-institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603460
Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds (p < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2rSBF2D
Diagnosis and following up of Ménière’s disease using multifrequency tympanometry—Cutoff values and temporal changes in measurements
This study aimed to verify cutoff values for G width (the width of bimodal peaks for the waveform obtained when measuring conductance at 2000Hz) in Japanese individuals diagnosed with Ménière's disease (MD) using multifrequency tympanometry (MFT) and to determine the relationship between the G width and ability to hear low-pitched sounds using measurements over time.
http://ift.tt/2r1jcjq
Monoclonal antibodies against IL-5 or IL-5 receptor alpha (mepolizumab, reslizumab, benralizumab), IL-13 (lebrikizumab, tralokinumab), IL-4 receptor alpha (dupilumab), Immune globuline E (IgE) (omalizumab), anti-Thymic Stromal Lymphopoitin (TSLP) (tezepelumab) and small molecule therapies such as prostaglandin D2 blockers (fevipiprant, timapiprant). New Anti-Eosinophil Drugs for asthma and COPD
http://sfaki.blogspot.com/2017/06/monoclonal-antibodies-against-il-5-or.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Next generation sequencing of oncogenes and tumor suppressor genes in odontogenic myxomas
Abstract
Background
Mutations previously considered drivers of malignant neoplasms also occur in benign tumors. From the biological perspective, the study of malignant and benign neoplasms is equally relevant. The study of rare tumors contributes to the understanding of the more common ones, as both could share the same hallmark genetic drivers. The identification of driver mutations in benign tumors is facilitated by the fact that they harbor quiet genomes. Pathogenic mutations have being described in benign epithelial odontogenic tumors, such as ameloblastomas and adenomatoid odontogenic tumors. However, the molecular pathogenesis of odontogenic myxoma (OM), a benign aggressive mesenchymal tumor, is still poorly characterized, precluding the development of personalized therapy. Aiming to find druggable genetic mutations, we investigated in OM, mutations in 50 genes commonly mutated in cancer.
Methods
We used targeted next generation sequencing to interrogate about 2,800 COSMIC mutations in OM.
Results
Missense single nucleotide variants were detected in KDR, TP53, PIK3CA, KIT, JAK3, however, these did not include pathogenic mutations.
Conclusion
Contrarily to other myxoid human neoplasms, these aggressive tumors do not harbor pathogenic mutations in genes commonly mutated in human cancers or if they do, these mutations probably occur in a low proportion of cases.
This article is protected by copyright. All rights reserved.
http://ift.tt/2t0uhlf
Incidence, prevalence, and risk of selected ocular disease in adults with atopic dermatitis
Ocular comorbidities are common in atopic dermatitis (AD) as the result of the disease itself or the use of medication. No large-scale epidemiologic data exist on the prevalence of ocular comorbidities in adults with AD.
http://ift.tt/2s9MDUq
Frequency of and risk factors for tumor upstaging after wide local excision of primary cutaneous melanoma
Detecting a more advanced stage of the primary melanoma after wide local excision and reconstruction can complicate patient counseling about prognosis, management of surgical margins, and indications for sentinel lymph node biopsy.
http://ift.tt/2sJgikB
Histopathologic features of melanoma in difficult-to-diagnose lesions: A case-control study
Dermatopathology is considered the gold standard for melanoma diagnosis, but a subset of cases is difficult to diagnose by histopathology.
http://ift.tt/2sa3Kpg
Healing lotion formula with proven superiority to Rx and therapeutic moisturizing lotions translates into improvements in stratum corneum biology and barrier resilience
Barrier integrity and therefore skin dryness falls along a spectrum—from normal to atopic—based on a number of genetic and environmental factors. The outermost layers of the epidermis (stratum corneum, SC) are key for maintaining skin health and barrier quality. For moderate to severe dry skin, the ideal moisturizer should provide initial and sustained hydration as well as repairing the barrier from within. Barrier resilience is indicated by improved SC parameters on regression. The goals of this research were to compare improvement in hydration from a healing test lotion with a combination of high glycerin, petrolatum, and fatty acid versus Rx and marketed therapeutic lotions and to demonstrate improvement in barrier resilience.
http://ift.tt/2sadzTU
Craniofacial and extracraniofacial anomalies in craniofacial macrosomia: A multicenter study of 755 patients
Craniofacial microsomia (CFM) is a congenital malformation of structures derived from the first and second pharyngeal arches leading to underdevelopment of the face. However, besides the craniofacial underdevelopment, extracraniofacial anomalies including cardiac, renal and skeletal malformation have been described. The aim of this study is to analyse a large population of patients with regard to demographics, typical phenotypes including craniofacial and extracraniofacial anomalies, and the correlations between the different variables of this condition.
http://ift.tt/2s2nF8x
Combined preoperative measurement of three inferior alveolar canal factors using computed tomography predicts the risk of inferior alveolar nerve injury during lower third molar extraction
A retrospective cohort study was performed to assess the clinical usefulness of combination assessment using computed tomography (CT) images in patients undergoing third molar extraction. This study included 85 patients (124 extraction sites). The relationship between cortication status, buccolingual position, and shape of the inferior alveolar canal (IAC) on CT images and the incidence of inferior alveolar nerve (IAN) injury after third molar extraction was evaluated. IAN injury was observed at eight of the 124 sites (6.5%), and in five of 19 sites (26.3%) in which cortication was absent+the IAC had a lingual position+the IAC had a dumbbell shape.
http://ift.tt/2rSqE1h
A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint
The purpose of this study was to compare the effectiveness of four non-surgical conservative treatment methods for temporomandibular disorders (TMD). The study group comprised 40 patients with unilateral TMD who fell into group II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were divided into four groups according to the treatment method: splint therapy, arthrocentesis, medical therapy, and low-level laser therapy. Magnetic resonance imaging (MRI) was performed before treatment and at the 1-month follow-up.
http://ift.tt/2r8bnME
The MO-meatocanalplasty: a modification of the M-meatoplasty to address the superior quadrants and the bony canal
Abstract
The meatoplasty of the external auditory canal is a frequently performed otologic procedure in recurrent otitis externa, eczema or frequent accumulation of cerumen due to a narrow meatus of the external ear canal. Numerous surgical techniques have been described. The M-meatoplasty described by Mirck for addressing the external meatus is widely used. However, this technique does not sufficiently enlarge the external ear canal in all cases. Specifically in patients where the ear canal narrowing is most prominent in the postero- and/or anterosuperior quadrants of the lateral meatus the technique needs some modifications. In these cases, an oblique conversion of the M-meatoplasty, the MO-meatocanalplasty, is useful. In cases where the bony canal is also narrow this modification allows for a bony canalplasty while avoiding a retro-auricular approach. The MO-meatocanalplasty can be used in combination with myringoplasty and tympanoplasty.
http://ift.tt/2rS9m4x
Atypical neurofibromatosis type 1 with unilateral limb hypertrophy mimicking overgrowth syndrome
Summary
Neurofibromatosis type 1 (NF1; OMIM 162200), a dominantly inherited multitumor syndrome, results from mutations in the Neurofibromin 1 (NF1) gene. We present the case of a Hungarian woman with the clinical phenotype of NF1 over her whole body and the clinical features of unilateral overgrowth involving her entire left leg. This unusual phenotype suggested either the atypical form of NF1 or the coexistence of NF1 and overgrowth syndrome. Direct sequencing of the genomic DNA isolated from peripheral blood revealed a novel frameshift mutation (c.5727insT, p.V1909fsX1912) in the NF1 gene. Next-generation sequencing of 50 oncogenes and tumour suppressor genes, performed on the genomic DNAs isolated from tissue samples and peripheral blood, detected only wild-type sequences. Based on these results, we concluded that the patient is affected by an unusual phenotype of NF1, and that the observed unilateral overgrowth of the left leg might be a rare consequence of the identified c.5727insT mutation.
http://ift.tt/2s28kVG
Clinical outcomes in a specialist male genital skin clinic: prospective follow-up of 600 patients
Summary
It is important to assess outcomes for medical interventions in order to focus scarce resources on outcomes with a known positive benefit. An open, observational study was performed to assess the clinical outcomes of 600 male patients with a genital skin problem attending a specialist secondary care dermatology facility. Patients were mainly referred by general practitioners and genitourinary medicine physicians. Outcome was measured at 3 and 6 months, and was determined by clinical examination and assessment of patient symptoms. The mean age of the group was 45.3 years. The commonest diagnoses were lichen sclerosus (30.5%), balanitis (17.3%), eczema (12.8%), lichen planus (7.3%), psoriasis (7.2%) and benign lesions (5.5%). The commonest presenting symptoms were genital rash (43%), genital soreness, pain or burning (17.5%), and penile lesions (15.7%). Lichen sclerosus and all forms of balanitis were more common in uncircumcised patients, whereas lichen planus was more common in circumcised males. Short-term outcome was excellent, with 11.5% of patients being reassured and discharged on their first visit, and after 6 months 58% of all patients were clear and 12% had improved. Only 4.5% reported no improvement in symptoms. Diagnostic biopsy demonstrated malignant or premalignant lesions in nearly a fifth of those having a procedure. Close working with urological and genitourinary medicine colleagues is important to manage the various aspects of male health.
http://ift.tt/2t0hRd4
Sinus hypoplasia in the cystic fibrosis rat resolves in the absence of chronic infection
Background
Sinus hypoplasia is a hallmark characteristic in cystic fibrosis (CF). Chronic rhinosinusitis (CRS) is nearly universal from a young age, impaired sinus development could be secondary to loss of the cystic fibrosis transmembrane conductance regulator (CFTR) or consequences of chronic infection during maturation. The objective of this study was to assess sinus development relative to overall growth in a novel CF animal model.
Methods
Sinus development was evaluated in CFTR−/− and CFTR+/+ rats at 3 stages of development: newborn; 3 weeks; and 16 weeks. Microcomputed tomography (microCT) scanning, cultures, and histology were performed. Three-dimensional sinus and skull volumes were quantified.
Results
At birth, sinus volumes were decreased in CFTR−/− rats compared with wild-type rats (mean ± SEM: 11.3 ± 0.85 mm3 vs 14.5 ± 0.73 mm3; p < 0.05), despite similar weights (8.4 ± 0.46 gm vs 8.3 ± 0.51 gm; p = 0.86). CF rat weights declined by 16 weeks (378.4 ± 10.6 gm vs 447.4 ± 15.9 gm; p < 0.05), sinus volume increased similar to wild-type rats (201.1 ± 3.77 gm vs 203.4 ± 7.13 gm; p = 0.8). The ratio of sinus volume to body weight indicates hypoplasia present at birth (1.37 ± 0.12 vs 1.78 ± 0.11; p < 0.05) and showed an increase compared with CFTR+/+ animals by 16 weeks (0.53 ± 0.02 vs 0.46 ± 0.02; p < 0.05). Rats did not develop histologic evidence of chronic infection.
Conclusion
CF rat sinuses are smaller at birth, but develop volumes similar to wild-type rats with maturation. This suggests that loss of CFTR may confer sinus hypoplasia at birth, but normal development ensues without chronic sinus infection. ©2017 ARSAAOA, LLC.
http://ift.tt/2rcgXZK
CMV-specific T Cell Monitoring Offers Superior Risk Stratification of CMV-seronegative Kidney Transplant Recipients of a CMV-seropositive Donor.
Background: Detectable CMV-specific T cells in CMV-seronegative kidney transplant recipients (KTRs) have been attributed to an absence of circulating antibodies despite CMV-sensitization. The diagnostic value of CMV-specific T cells, however, needs to be implemented in risk stratification for CMV-replication. Methods: 326 KTRs were studied and classified with respect to CMV-serostatus and presence of CMV-specific T cells. Samples were collected pretransplantation, at +1, +2, and +3 months posttransplantation. CMV-specific T cells directed to CMV-IE1 and CMV-pp65 were measured by interferon-[gamma] Elispot assay. Results: 19/67 D+R- KTRs (28%) showed pretransplant CMV-specific T cells. Although no differences were observed for CMV-replication, KTRs with CMV-specific T cells presented with lower initial and peak CMV-loads (p
http://ift.tt/2t0bZ3o
http://ift.tt/2t0bZ3o
Blockade of HLA Antibody-Triggered Classical Complement Activation in Sera from Subjects Dosed with the Anti-C1s Monoclonal Antibody TNT009 - Results from a Randomized First-in-Human Phase 1 Trial.
http://ift.tt/2s2feub
DHRS9 is a Stable Marker of Human Regulatory Macrophages.
http://ift.tt/2t0iLq0
Inhibition of spleen tyrosine kinase reduces renal allograft injury in a rat model of acute antibody-mediated rejection in sensitized recipients.
http://ift.tt/2s210cE
Reduction in all-cause otitis media-related outpatient visits in children after PCV10 introduction in Brazil
by Ana L. Sartori, Ruth Minamisava, Ana L. Bierrenbach, Cristiana M. Toscano, Eliane T. Afonso, Otaliba L. Morais-Neto, José L. F. Antunes, Elier B. Cristo, Ana Lucia Andrade
Few studies have reported the effect of 10-valent pneumococcal conjugate vaccine (PCV10) on otitis media (OM) in infants. In particular, no population-based study in upper-middle income countries is available. In 2010, Brazil introduced PCV10 into its routine National Immunization Program using a 3+1 schedule. We measured the impact of PCV10 on all-cause OM in children. An interrupted time-series analysis was conducted in Goiânia/Brazil considering monthly rates (per 100,000) of all-cause OM outpatient visits in children aged 2–23 months. We used case-based data from the Outpatient Visits Information System of the Unified Health System coded for ICD-10 diagnosis for the period of August/2008 to July/2015. As a comparator, we used rates of outpatient visits due to all-other causes. The relative reduction of all-cause OM and all-other causes of outpatient visits were calculated as the difference between the predicted and observed cumulative rates of the PCV10 post-vaccination period. We then subtracted the relative reduction of all-other causes of outpatient visits from all-cause OM to obtain the impact of PCV10 on OM. In total, 6,401 OM outpatient visits were recorded in 4,793 children aged 2–23 months. Of these, 922 (19.2%) children had more than one OM episode. A significant reduction in all-cause OM visits was observed (50.7%; 95%CI: 42.2–59.2%; p = 0.013), while the reduction in visits due to all-other causes was 7.7% (95% CI 0.8–14.7%; phttp://ift.tt/2rQvjRk
Biocontrol of the toxigenic plant pathogen Fusarium culmorum by soil fauna in an agroecosystem
Abstract
In 2011 and 2013, a field experiment was conducted in a winter wheat field at Adenstedt (northern Germany) to investigate biocontrol and interaction effects of important members of the soil food web (Lumbricus terrestris, Annelida; Folsomia candida, Collembola and Aphelenchoides saprophilus, Nematoda) on the phytopathogenic fungus Fusarium culmorum in wheat straw. Therefore, soil fauna was introduced in mesocosms in defined numbers and combinations and exposed to either Fusarium-infected or non-infected wheat straw. L. terrestris was introduced in all faunal treatments and combined either with F. candida or A. saprophilus or both. Mesocosms filled with a Luvisol soil, a cover of different types of wheat straw and respective combinations of faunal species were established outdoors in the topsoil of a winter wheat field after harvest of the crop. After a time span of 4 and 8 weeks, the degree of wheat straw coverage of mesocosms was quantified to assess its attractiveness for the soil fauna. The content of Fusarium biomass in residual wheat straw and soil was determined using a double-antibody sandwich (DAS)-ELISA method. In both experimental years, the infected wheat straw was incorporated more efficiently into the soil than the non-infected control straw due to the presence of L. terrestris in all faunal treatments than the non-infected control straw. In addition, Fusarium biomass was reduced significantly in all treatments after 4 weeks (2011: 95–99%; 2013:15–54%), whereupon the decline of fungal biomass was higher in faunal treatments than in non-faunal treatments and differed significantly from them. In 2011, Fusarium biomass of the faunal treatments was below the quantification limit after 8 weeks. In 2013, a decline of Fusarium biomass was observed, but the highest content of Fusarium biomass was still found in the non-faunal treatments after 8 weeks. In the soil of all treatments, Fusarium biomass was below the quantification limit. The earthworm species L. terrestris revealed a considerable potential as an effective biocontrol agent contributing to a sustainable control of a Fusarium plant pathogen in wheat straw, thus reducing the infection risk for specific plant diseases in arable fields.
http://ift.tt/2s97eZ1
A comparative study on the efficacy of submucosal injection of dexamethasone versus methylprednisolone in reducing post operative sequelae following third molar surgery
Publication date: Available online 8 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Daniel Lim, Wei Cheong Ngeow
PurposeTo compare the efficacy of pre-operative submucosal injection of 4mg dexamethasone and 40mg methylprednisolone in reducing post-operative sequalae following surgical removal of impacted mandibular third molar.MethodsSixty five patients who required surgical removal of impacted mandibular third molar Class 2 or Position B (Pell & Gregory Classification) were included in this prospective, randomized, and double-blinded study. Patients were randomly assigned to three groups: dexamethasone, methylprednisolone or placebo control. Surgery was performed under local anesthesia. Baseline measurements were done pre-operatively and subsequent assessment were made on post-operative day 1, 2, 5 and 7 to measure post-operative facial swelling using 2 linear measurements, inter-incisal mouth opening width, and visual analog scale for pain. The amount of analgesic consumed was recorded. Wound healing was also assessed on post operative day 7. Descriptive and multivariate statistics were computed and the significance was set at P < 0.05.ResultsBoth methylprednisolone and dexamethasone significantly reduced swelling and trismus (Kruskal-Wallis test: P<0.05), while the methylprednisolone group experienced significantly less pain (Kruskal-Wallis test: P< 0.05) and consumed less analgesic (Chi-square test: P < 0.05) during the early post-operative days.ConclusionThe finding suggests that a single pre-operative dose of dexamethasone or methylprednisolone was equally effective in reducing post-operative swelling and trismus. Pain control by these corticosteroids, however, was variable.
http://ift.tt/2rbexL2
Local Application of Platelet-Rich Fibrin during Lower Third Molar Extraction Improves Treatment Outcomes
Publication date: Available online 8 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yun He, Junliang Chen, Yue Huang, Qin Pan, Minhai Nie
PurposeApplication of platelet-rich fibrin (PRF) during tooth extraction is able to accelerate wound healing, stimulate osseous and soft tissue regeneration and reduce unwanted side effects. The aim of this meta-analysis was to investigate the effect of local application of PRF on controlling post-operative signs and symptoms following the extraction of an impacted lower third molar.MethodsA systematic search of Pubmed, Web of Science, EMBASE and Cochrane Library was performed to identify all studies published up to October 2016 that investigate the effect of PRF in lower third molar extraction. Pain, swelling, trismus, alveolar osteitis (AO) and osteoblastic activity were extracted to evaluate the effect of PRF. After quality assessment, meta-analysis was performed using RevMan 5.3 software.ResultsAfter the search and selection process, ten studies were selected in the present meta-analysis, including 468 cases of PRF application and 467 cases of non-PRF application. Nine of the studies were randomized controlled trials, including seven split-mouth studies and there was one retrospective case-control study. The results indicated that PRF significantly relieves pain (p = 0.01) and 3-day postoperative swelling (p = 0.03) and reduces the incidence of AO (p < 0.0001). However, there were no significant differences between PRF and non-PRF groups with respect to 1-day post-operative swelling and osteoblastic activity.ConclusionLocal application of PRF after lower third molar extraction is a valid method in relieving pain and 3-day postoperative swelling and reducing the incidence of AO. For patients undergoing complicated surgical extraction, PRF might be a recommendation for local application into the sockets.
http://ift.tt/2rGVBad
Facial Fractures in Patients with Firearm Injuries: Profile and Outcomes
Publication date: Available online 8 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shelly Abramowicz, Veerasathpurush Allareddy, Sankeerth Rampa, Min Kyeong Lee, Romesh P. Nalliah, Veerajalandhar Allareddy
PurposeFirearm injuries are a major public health issue in the United States (US). The objective of this study was to examine characteristics and outcomes of patients presenting to emergency departments (ED) with facial fractures attributed to firearm injuries (FAIs).Materials and MethodsThe Nationwide Emergency Department Sample for the years 2008 to 2013 was used. All patients that visited an ED with a FAI and facial fractures were selected. The study focused on the following variables: (1) demographics, (2) types of facial fractures, (3) disposition status after ED visit or subsequent hospitalization, (4) charges (ED and hospitalization), and (5) patient outcomes. Inclusion criteria were a visit to hospital based ED with facial fractures and an external cause of FAI. Descriptive statistics were used to summarize findings. Multivariable logistic regression analysis was used to examine the simultaneous effects of patient related factors on ED mortality.ResultsDuring the study period, a total of 15,469 patients (mean age 34 years) visited hospital based EDs with a facial fracture attributed to FAIs. Majority were uninsured males. The most common etiology for FAI was assault. Most common facial fractures were open mandibular fractures and open maxillary/malar bone fractures. Approximately 27% had a concomitant intra-cranial injury. Following the ED visit, 74% were admitted. Mean ED charge per patient was $6,403 and total ED charges across the US was $76.48 million. Mean hospitalization charge per patient was $167,203. Total hospitalization charges across the US was $1.9 billion. Those with intra-cranial injuries (OR=21.21, 95% CI=7.16 – 62.85, p<0.01), uninsured (OR=4.24, 95% CI=1.44 – 12.51, p<0.01), and those residing in high household income areas (OR=5.60, 95% CI=2.51 – 12.46, p<0.01) were high risk groups for ED mortality.ConclusionsFAIs require significant resources for stabilization and treatment by EDs. The present study highlights the burden and impact of facial fractures in patients with FAIs in the US.
http://ift.tt/2rbfqD6
Burned Out or Bummed Out
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roger A. Meyer
http://ift.tt/2rGHiCu
Evaluation of Oral and Maxillofacial Surgery Residents’ Operative Skills: Feasibility & Engagement Study Using SIMPL Software for a Mobile Phone
Publication date: Available online 8 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Leonard B. Kaban, Alyssa Cappetta, Brian George, Edward Lahey, Jordan Bohnen, Maria J. Troulis
PurposeThere are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study is to determine the feasibility of using a Smartphone application SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. We hypothesized that these goals would be achieved because the process is convenient and efficient.MethodsThis is a prospective feasibility and engagement study using SIMPL to evaluate resident operative skills. SIMPL requires the attending surgeon to answer three multiple choice questions: 1. What level of help (Zwisch scale) was required by the trainee? 2. What was the level of performance? 3. How complex was the case? The evaluator can also dictate a narrative. The sample was composed of three faculty and three volunteer senior residents. Predictor variables were the surgeons, trainees and procedures performed. Outcome variables included: number and percent procedures performed by faculty/resident pairs assessed; time required to complete assessments, time lapsed to submission; percent assessments with narratives; and residents' response rates.ResultsFrom March through June 2016, 151 procedures were performed in the operating room by the faculty/resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n=75/107) was under two minutes. The time lapsed to submission was < 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident.ConclusionsSIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. We plan additional prospective trials to further assess this tool.
http://ift.tt/2rbn68z
Integrative analysis of mRNA and miRNA expression profiles in oral lichen planus: preliminary results
Publication date: Available online 8 June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Junjun Chen, Guanhuan Du, Yufeng Wang, Linjun Shi, Jun Mi, Guoyao Tang
ObjectiveOral lichen planus (OLP) isa chronic inflammatory disease of unknown etiology that is considered an Oral Potentially Malignant Disorders. The aim of the present study was to analyze candidate microRNAs (miRNAs) and genes from patients with OLP and healthy controls (HC).DesignBiopsies of the oral mucosa were collected from patients with OLP (n=9) and HC (n=4). Differentially expressed miRNAs (DEMs) and differentially expressed genes (DEGs) were screened by next generation sequencing with DESeq and edgeR software algorithm.ResultsA total of 94 DEMs and 599 DEGs were detected in OLP. Potential regulatory miRNAs and genes were obtained by analyzing miRNA-mRNA networks. Of these, five downregulated miRNAs: hsa-miR-135a-5p (P=0.33), hsa-miR-128-3p (P=0.03), hsa-miR-218-5p (P=0.01), hsa-miR-125a-5p (P=0.01), and hsa-let-7e-5p (P=0.04) were the most promising biomarkers in OLP compared to HC. The identified DEGs were significantly enriched in 'inflammatory' events and immune-related terms through KEGG and GO analysis.ConclusionsThe integrative analysis of mRNA and miRNA profiles provides important information to elucidate gene expression mechanisms and a comprehensive perspective to study the etiology and pathogenesis of OLP.
http://ift.tt/2sIvfTP
Evaluation of Trabecular Structure Changes in Osteoarthritis of the Temporomandibular Joint with Cone Beam CT Imaging
Publication date: Available online 8 June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Xin liang, Shuming Liu, Xingmin Qu, Zhihui Wang, Jianbo Zheng, Xiaoyan Xie, Guowu Ma, Zuyan Zhang, Xuchen Ma
ObjectivesTo explore the possibility of using 2D image assessments in combination with cone beam computed tomography (CBCT) on temporomandibular joint osteoarthritis (TMJOA) patients to enhance the clinical significance and applicability of the CBCT findings of TMJOA changes.Study Design52 patients with unilateral TMJOA and 40 healthy adults who had had CBCT scans in preparation for orthodontic treatment were selected for this study. Temporomandibular joint (TMJ) images were acquired in the CBCT scans. All images were classified into four phases (slight erosion, widespread erosion, appearance of bone maintenance, and partial loss of condylar head with a remodelled cortical surface) and four levels of severity (absent, slight, moderate, and extensive). Quantitative microstructural analysis including bone value fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb,Th), and trabecular separation (Tb.Sp) of each image was performed using a customized software.ResultsIn unilateral TMJOA patients, the affected side had significantly higher BV/TV and Tb.N and significant lower Tb.Sp than the unaffected side. Compared to the healthy patients, the affected joints of the TMJOA patients had significantly higher BV/TV and Tb.Th and significantly lower Tb.N and Tb.Sp. No significant difference was found among different phase groups or different severity levels.ConclusionsCBCT combined with a software investigation protocol for microstructure measurement can be used to provide reliable trabecular parameters in assessing TMJOA.
http://ift.tt/2s9lmBx
18F-Fluoromisonidazole positron emission tomography (FMISO-PET) may reflect hypoxia and cell proliferation activity in oral squamous cell carcinoma
Publication date: Available online 8 June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jun Sato, Yoshimasa Kitagawa, Shiro Watanabe, Takuya Asaka, Noritaka Ohga, Kenji Hirata, Shozo Okamoto, Tohru Shiga, Masanobu Shindoh, Yuji Kuge, Nagara Tamaki
BackgroundHypoxia is a common feature and prognostic factor in cancer. 18F-fluoromisonidazole (FMISO) - positron emission tomography (PET) can detect tumor hypoxia noninvasively. The aim of this study is to assess the correlations between FMISO- and 18F-fluorodexyglucose (FDG) -PET parameters with cell proliferation and hypoxia in patients with oral squamous cell carcinoma (OSCC).MethodsTwenty-three preoperative patients with OSCC were included. The tumor-muscle ratio (TMR) of FMISO-PET, the maximum standardized uptake values (SUVmax) of FDG-PET, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured. Ki-67 and hypoxia-inducible factor-1α (HIF-1α) expression was immunohistochemically evaluated.ResultsFMISO TMR (P = 0.003) and FDG SUVmax (P = 0.04) were significantly higher in patients with high than low expression of Ki-67. FMISO TMR (P = 0.006) and FDG SUV max (P = 0.01) were also significantly higher in patients with than without HIF-1α expression. MTV was not significantly related to either Ki-67 or HIF-1α expression. Multivariate analysis showed that FMISO TMR was independently predictive of Ki-67 (P = 0.002; odds ratios, 31.1) and HIF-1α (P = 0.049; odds ratio, 10.5) expression.ConclusionFMISO-PET showed significant relationships with Ki-67 and HIF-1α expression, which are key features of cell proliferation and hypoxia in OSCC.
http://ift.tt/2sJ69V4
Chronic fibrosing osteomyelitis of the jaws: An important cause of recalcitrant facial pain. A clinicopathologic study of 331 cases in 227 patients
Publication date: Available online 8 June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Lawrence I. Goldblatt, William R. Adams, Kenneth J. Spolnik, Kevin A. Deardorf, Edwin T. Parks
ObjectiveA retrospective and followup analysis of 331 cases of Chronic Fibrosing Osteomyelitis of the Jaws (CFOJ) in 227 patients.Study DesignDemographic, clinical, surgical and microscopic characteristics were tabulated for all patients. A followup mail survey was used to determine degree of symptom relief experienced since surgery.ResultsThe female/male ratio approached 7/1 with a mean age of 53 years. The most common sites were the mandibular posterior followed by the maxillary posterior regions. Consistent clinical findings included intractable jaw pain mimicking odontogenic origin but unresponsive to usual therapies, minimal or undetectable radiographic abnormalities on plain films but dramatic radiolucencies detected on Cone Beam Computerized Tomography, and large cavities either empty or filled with blood mixed with lipid globules encountered at surgery. The most common histomorphologic findings were vital lamellar bone, prominent resting and reversal lines, microshards and splaying of trabeculae, rounded trabeculae, marrow fibrosis and pools of erythrocytes and lipid globules, often together. Moderate to complete relief of symptoms for periods up to 108 months post-surgery were reported by 83% of the 70 patients who returned the survey.ConclusionsBased upon this study, CFOJ is a unique entity with consistent clinicopathologic features. Its features suggest a pathogenesis based on bone marrow ischemia. CFOJ can be treated on a rational basis with a justifiable expectation of success and probably cure.
http://ift.tt/2s9Awqz
Is It Time to Extend Synoptic Reporting to Include Non-Malignant Oral Epithelial and Lichenoid Lesions?
Publication date: Available online 8 June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Paul C. Edwards
http://ift.tt/2sIFFCK
The variant of pri-mir-26a-1 polymorphism is associated with the decreased risk of betel quid-related oral premalignant lesions and oral squamous cell carcinoma
Publication date: Available online 8 June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Cheng-Mei Yang, Chien-Chou Chen, Yu-Kai Tseng, Sin-Jhih Huang, Huei-Han Liou, Yi-Cheng Lee, Jang-Hwa Lee, Jyh-Seng Wang, Hung-Chih Chen, Chao-Chuan Chi, Bor-Hwang Kang, Yun-Chung Lin, Kuo-Wang Tsai, Luo-ping Ger
ObjectivesThis case-control study evaluated the association of the single nucleotide polymorphism rs7372209 (T>C) in pri-mir-26a-1 with the risk and progression of betel quid (BQ)-related oral premalignant lesions (OPLs) and oral squamous cell carcinoma (OSCC).Study DesignIn total, 597 BQ chewers were recruited: 196 healthy controls, 241 OPL patients, and 160 OSCC patients. The genotypes were determined using the TaqMan real-time assay.ResultsThe C/T + T/T genotypes and T allele in pri-mir-26a-1 were correlated with a decreased risk of BQ-related OPLs (p=0.038 and 0.005, respectively), oral leukoplakia (OL; p=0.01 and 0.001, respectively), and advanced-stage OSCC (p=0.021 and 0.004, respectively). The effects of the C/T + T/T genotypes and T allele on the decreased risk of OPLs were potent in the old age group (both Pinteraction <0.001), heavy smokers (Pinteraction ≤0.003 and 0.006, respectively), and alcohol drinkers (Pinteraction ≤ 0.004 and 0.001, respectively). Furthermore, among OSCC patients, the C/T + T/T genotypes and T allele were associated with a decreased risk of advanced pathological stage (p=0.032) and lymph node involvement (p = 0.017).ConclusionBQ chewers carrying the T allele or C/T + T/T genotypes in pri-mir-26a-1 may have a decreased risk of OL, OPLs, and advanced-stage OSCC.
http://ift.tt/2s9lkJV
Congenital nasal obstruction in infants: A retrospective study and literature review
Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Vijay A. Patel, Michele M. Carr
ObjectivesTo identify etiologies of congenital nasal obstruction and describe clinical practice patterns in the evaluation, diagnosis, and treatment of symptomatic infants.MethodsAn electronic chart review from 1/1/2006–10/1/2016 for all patients with a diagnosis of nasal obstruction within the first six months of life using ICD-9 and 10 codes 478.19 and J34.89.ResultsA total of 34 patients were evaluated by the Division of Otolaryngology for this chief complaint. 38% of neonates were born premature and 32% were admitted to the NICU at birth, with a female-to-male ratio of 1:1.4. Presenting signs and symptoms included: stertor (44%), cyanosis (24%), stridor (24%), retractions (21%), rhinorrhea (21%), apnea (12%), and epistaxis (8%). 47% of patients received ancillary radiographic imaging (CT or MRI). Diagnoses observed include: midnasal stenosis (38%), pyriform aperture stenosis (21%), choanal stenosis (12%), dacryocystocele (6%), microrhinia (6%), septal deviation (6%), nasopharyngeal reflux (3%), nasopharyngeal teratoma (3%), neonatal rhinitis (3%), and pharyngeal wall collapse (3%). 71% of patients were noted to have bilateral nasal obstruction. 41% of infants were found to have an associated ear, nose, and throat anomaly. 15% of patients required surgical intervention. The mean time-to-resolution was 240 days.ConclusionCongenital nasal obstruction has a broad differential diagnosis: the timing, onset, and laterality of symptoms can provide insights into the source of upper airway compromise. Most infants improve through conservative management (i.e. suctioning, humidification) and medical therapies (i.e. intranasal drops, nasal sprays).
http://ift.tt/2rRIh1e
Visual cortex activation decrement following cochlear implantation in prelingual deafened children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Jiahao Liu, Maojin Liang, Yuebo Chen, Yajing Wang, Yuexin Cai, Suijun Chen, Ling Chen, Xianghui Li, Zeheng Qiu, Jiajia Jiang, Junbo Wang, Yiqing Zheng
ObjectiveVisual take-over of the auditory cortex in prelingual deaf children has been widely reported. However, there have been few studies on visual cortex plasticity after cochlear implantation (CI). In this study, we investigated the hypothesis that extrinsic auditory stimulation following CI in prelingual deafened children can induce visual cortex plasticity.MethodVisual evoked potentials (VEPs) were recorded in 37 CI children (4 groups with different use times) and 8 control subjects, in response to sound and nonsound stimuli. Latency and amplitude were analyzed for the P1, N1 and P2 components on the Oz electrode. Comparisons of VEP were conducted between the sound and nonsound stimuli and among different groups in order to view evidence of visual cortex reorganization.ResultsThe latency of the P2 component was significantly longer at the occipital site (Oz) in CI 0M than those in the other four groups. After the effect of age was excluded, a significant negative correlation was found between CI usage and P2 latency of nonsound stimuli. Occipital P1N1 latency and P1 amplitude were not affected by group or stimulus category. However, the N1 and P2 amplitudes were significantly larger in response to a sound stimulus than to a nonsound stimulus.ConclusionOur findings suggest that P2 latency develops with CI usage and may be a biomarker of visual cortex plasticity.
http://ift.tt/2r7wleC
Genetic Variants in the IL-4/IL-13 Pathway Influence Measles Vaccine Responses and Vaccine Failure in Children from Mozambique
Viral Immunology , Vol. 0, No. 0.
http://ift.tt/2rRL76A
Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial
Abstract
Purpose
The aim of this study was to compare the anti-inflammatory potential of two pharmacotherapy protocols based on the parameters of pain, trismus, and swelling, after extraction of third molars.
Methods
Thirty patients selected with symmetrical impaction of third molars were submitted to surgical procedures in both sides in different times. For one group, dexamethasone was used for 3 days, and for another group diclofenac sodium was also used for the same period. The main variables analyzed were the visual analogue pain scale (VAS), but others were also analyzed such as swelling and trismus, which were submitted to statistical analysis.
Results
The results had no difference regarding the length of procedures (p = 0.986) and the pain in the immediate and 4-h postoperative period (p = 0.723 and 0.541). The rescue analgesic consumption was higher (p < 0.05) when using the protocol with diclofenac sodium. The variables mouth opening (p < 0.05) and swelling (p < 0.05) were significantly better when using the protocol with dexamethasone in the postoperative period.
Conclusions
Medical protocol with the use of dexamethasone in the postoperative period was more effective in controlling pain, trismus, and swelling, after the extraction of third molars, when compared to diclofenac sodium.
http://ift.tt/2rQZMyY
Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial
Abstract
Purpose
The aim of this study was to compare the anti-inflammatory potential of two pharmacotherapy protocols based on the parameters of pain, trismus, and swelling, after extraction of third molars.
Methods
Thirty patients selected with symmetrical impaction of third molars were submitted to surgical procedures in both sides in different times. For one group, dexamethasone was used for 3 days, and for another group diclofenac sodium was also used for the same period. The main variables analyzed were the visual analogue pain scale (VAS), but others were also analyzed such as swelling and trismus, which were submitted to statistical analysis.
Results
The results had no difference regarding the length of procedures (p = 0.986) and the pain in the immediate and 4-h postoperative period (p = 0.723 and 0.541). The rescue analgesic consumption was higher (p < 0.05) when using the protocol with diclofenac sodium. The variables mouth opening (p < 0.05) and swelling (p < 0.05) were significantly better when using the protocol with dexamethasone in the postoperative period.
Conclusions
Medical protocol with the use of dexamethasone in the postoperative period was more effective in controlling pain, trismus, and swelling, after the extraction of third molars, when compared to diclofenac sodium.
http://ift.tt/2rQZMyY
Exaggerated T Follicular Helper Cell Responses in LRBA Deficiency Due to Failure of CTLA4-Mediated Regulation
Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Fayhan J. Alroqi, Louis-Marie Charbonnier, Safa Baris, Ayca Kiykim, Janet Chou, Craig D. Platt, Abdulrahman Algassim, Sevgi Keles, Bandar K. Al Saud, Fowzan S. Alkuraya, Michael Jordan, Raif S. Geha, Talal A. Chatila
PurposeLRBA (lipopolysaccharide-responsive beige like anchor protein) and CTLA4 (cytotoxic T lymphocyte antigen 4) deficiencies give rise to overlapping phenotypes of immune dysregulation and autoimmunity, with dramatically increased frequencies of circulating T Follicular helper (cTFH) cells. We sought to determine the mechanisms of cTFH cell dysregulation in LRBA deficiency and the utility of monitoring cTFH cells as a correlate of clinical response to CTLA4-Ig therapy.MethodscTFH cells and other lymphocyte subpopulations were characterized. Functional analyses included in vitro TFH cell differentiation and cTFH/naïve B cell co-cultures. Serum soluble IL-2 receptor alpha chain (sIL-2Rα), and in vitro immunoglobulin production by cultured B cells were quantified by ELISA.ResultscTFH cell frequencies in patients with LRBA or CTLA4 deficiency sharply declined with CTLA4-Ig therapy, in parallel with other markers of immune dysregulation including sIL-2Rα, CD45RO+CD4+ effector T cells and auto-antibodies, and predictive of favorable clinical responses. cTFH cells in patients with LRBA deficiency were biased towards a TH1-like cell phenotype, which was partially reversed by CTLA4-Ig therapy. LRBA-sufficient but not -deficient regulatory T (Treg) cells suppressed in vitro TFH cell differentiation in a CTLA4-dependent manner. LRBA deficient TFH cells supported in vitro antibody production by naïve LRBA-sufficient B cells.ConclusionscTFH cell dysregulation in LRBA deficiency reflects impaired control of TFH differentiation due to profoundly decreased CTLA4 expression on Treg cells, and probably contributes to autoimmunity in this disease. Serial monitoring of cTFH cell frequencies is highly useful in gauging the clinical response of LRBA deficient patients to CTLA4-Ig therapy.
Teaser
LRBA and CTLA4 deficiencies are associated with dysregulated TFH cell responses, which may contribute to autoimmunity in these disorders. Monitoring circulating TFH cells may help gauge response to therapy.http://ift.tt/2s0LPAq
Flow cytometric measurement of STAT1 and STAT3 phosphorylation in CD4+ and CD8+ T cells - Clinical applications in PID diagnostics
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael Bitar, Andreas Boldt, Stefanie Binder, Michael Borte, Karim Kentouche, Stephan Borte, Ulrich Sack
Teaser
Flow cytometry-based pSTAT1 and pSTAT3 profiling is an effective diagnostic tool to identify PID patients with aberrations in the STAT1 or STAT3 gene.http://ift.tt/2sZ1VaW
Prenatal, intrapartum, and postnatal factors are associated with pediatric eosinophilic esophagitis
Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Elizabeth T. Jensen, Jonathan T. Kuhl, Lisa J. Martin, Marc E. Rothenberg, Evan S. Dellon
BackgroundMultiple lines of evidence point to the potential importance of early-life environmental factors in the rapid rise in incidence of eosinophilic esophagitis (EoE), but potential exposures have not been extensively studied.ObjectiveTo assess the association between prenatal, intrapartum, and postnatal factors and the development of pediatric EoE using a case-control study.MethodsCases of EoE were recruited from an existing registry at Cincinnati Children's Hospital Medical Center (CCHMC). Population-based community controls were identified from a separate CCHMC registry. Mothers of study subjects were contacted and completed a web-based questionnaire. Crude and adjusted models were used to estimate associations.ResultsMothers of 127 cases and 121 controls were included. We observed a positive association between several early-life factors and EoE, including prenatal (maternal fever: aOR 3.18; 95% CI 1.27, 7.98; preterm labor: aOR 2.18; 95% CI 1.06, 4.48), intrapartum (Cesarean delivery: aOR 1.77; 95% CI 1.01, 3.09) and infancy factors (antibiotic use: aOR 2.30; 95% CI 1.21, 4.38; use of an acid-suppressant: aOR 6.05; 95% CI 2.55, 14.40). We observed an inverse association between having a furry pet in infancy and EoE (aOR 0.58; 95% CI 0.34, 0.97). No associations were observed for breastfeeding or maternal multivitamin or folic acid supplement use.ConclusionEarly-life factors including maternal fever, preterm labor, Cesarean delivery, and antibiotic or acid suppressant use in infancy were associated with risk of pediatric EoE; having a pet in the home was protective. These results add to growing evidence that implicate early-life exposures in EoE pathogenesis.
Teaser
Heritability estimates for EoE suggest that both genetics and early-life environmental factors contribute to disease pathogenesis. The present study identifies several prenatal, intrapartum, and postnatal factors associated with EoE susceptibility.http://ift.tt/2sYT74N
Nitric oxide induces human CLA+CD25+Foxp3+ regulatory T cells with skin homing potential
Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Cunjing Yu, Amanda Fitzpatrick, Duanduan Cong, Chengcan Yao, Jinah Yoo, Andrew Turnbull, Jürgen Schwarze, Mary Norval, Sarah E.M. Howie, Richard B. Weller, Anne L. Astier
Phototherapy releases nitric oxide and can reduce symptoms in Atopic Dermatitis (AD). Nitric oxide induced suppressive regulatory T cells and, post-phototherapy, a clinical improvement in AD correlated with an increased ratio of Tregulatory:Teffector cells.
http://ift.tt/2s1fn0V
Hematopoietic stem cell transplantation in patients with Gain of Function STAT1 Mutation
Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jennifer W. Leiding, Satoshi Okada, David Hagin, Mario Abinun, Anna Shcherbina, Dmitry N. Balashov, Vy H.D. Kim, Adi Ovadia, Stephen L. Guthery, Michael Pulsipher, Desa Lilic, Lisa A. Devlin, Sharon Christie, Mark Depner, Sebastian Fuchs, Annet van Royen-Kerkhof, Caroline Lindemans, Aleksandra Petrovic, Kathleen E. Sullivan, Nancy Bunin, Sara Sebnem Kilic, Fikret Arpaci, Oscar de la Calle-Martin, Laura Martinez-Martinez, Juan Carlos Aldave, Masao Kobayashi, Teppei Ohkawa, Kohsuke Imai, Akihiro Iguchi, Chaim M. Roifman, Andrew R. Gennery, Mary Slatter, Hans D. Ochs, Tomohiro Morio, Troy R. Torgerson
BackgroundGain of function mutations in signal transducer and activator of transcription 1 (GOF-STAT1) cause a susceptibility to a range of infections, autoimmunity, immune dysregulation, and combined immunodeficiency. Disease manifestations can be mild or severe and life threatening. Hematopoietic stem cell transplantation (HSCT) has been utilized in some patients with more severe symptoms to treat and cure the disorder. The outcome of HSCT for this disorder is, however, not well established.ObjectiveTo aggregate the worldwide experience of HSCT in GOF-STAT1 patients and to assess outcomes including donor engraftment, overall survival, graft versus host disease, and transplant related complications.MethodsData were collected from an international cohort of 15 GOF-STAT1 patients that had undergone HSCT using a variety of conditioning regimens and donor sources. Retrospective data collection allowed the outcome of transplantation to be assessed. In vitro functional testing was performed to confirm that each of the identified STAT1 variants was, in-fact, a gain of function mutation.ResultsPrimary donor engraftment in this cohort of 15 GOF-STAT1 patients was 74% and overall survival was only 40%. Secondary graft failure was common (50%) and post-transplant event free survival was poor (10% by 100 days). A subset of patients developed hemophagocytic lymphohistiocytosis (HLH) prior to their transplant, contributing to their poor outcomes.ConclusionOur data indicate that HSCT for patients with GOF-STAT1 mutations is curative but has significant risk of secondary graft failure and death.
Teaser
Hematopoietic stem cell transplantation (HSCT) in GOF-STAT1 patients can be curative. HSCT in this cohort is however associated with a relatively high rate of graft failure and other complications that lead to decreased overall survival.http://ift.tt/2sYGA1u
Mutation of Angiopoietin-1 Gene Associates with a New Type of Hereditary Angioedema
Publication date: Available online 8 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Valeria Bafunno, Davide Firinu, Maria D'Apolito, Giorgia Cordisco, Stefania Loffredo, Angelica Leccese, Maria Bova, Maria Pina Barca, Rosa Santacroce, Marco Cicardi, Stefano Del Giacco, Maurizio Margaglione.
BackgroundHereditary angioedema (HAE) is a rare genetic disease usually due to mutation within the C1 inhibitor or the coagulation Factor XII gene. However, in a series of patients with HAE no causative variants have been described and the pathophysiology of the disease remains unknown (U-HAE). Identification of causative genes in U-HAE is valuable for understanding the cause of the disease.ObjectiveWe conducted genetic studies in Italian patients with U-HAE to identify novel causative genes.MethodsAmong patients belonging to 10 independent families and unrelated index patients with U-HAE disease recruited from the Italian network for C1-INH-HAE (ITACA), we selected a large multiplex family with U-HAE and performed whole-exome sequencing. The angiopoietin-1 gene (ANGPT1) was investigated in all patients with familial or sporadic U-HAE. The effect of ANGPT1 variants was investigated by in silico prediction and using patients and control plasmas and transfected cells.ResultsWe identified a missense mutation (ANGPT1, c.807G>T, p.A119S) in a family with U-HAE. The ANGPT1 p.A119S variant was detected in all members of the index family with U-HAE but not in asymptomatic family members, nor in an additional 20 patients with familial U-HAE, 22 patients with sporadic U-HAE, and 200 controls. Protein analysis of the plasma of patients revealed a reduction of multimeric forms and a reduced ability to bind the natural receptor "tunica interna endothelial cell kinase-2" (TIE2) of the ANGPT1 p.A119S variant. The recombinant mutated ANGPT1 p.A119S formed a reduced amount of multimers and showed a reduced binding capability to its receptor.ConclusionANGPT1 impairment is associated with angioedema and ANGPT1 variants can be the basis of HAE.
Graphical abstract
Teaser
A missense variant in the angiopoietin-1 gene (ANGPT1) represents a novel and independent mechanism leading to vascular permeability and angioedema. Impairment of the endothelial ANGPT1-TIE2 ligand-receptor system may be involved in the pathophysiology of HAE.http://ift.tt/2s0WcUH
Increased IL-13 expression is independently associated with neo-osteogenesis in chronic rhinosinusitis
Source:Journal of Allergy and Clinical Immunology
Author(s): Sakiko Oue, Mahnaz Ramezanpour, Sathish Paramasivan, Dijana Miljkovic, Clare M. Cooksley, Ahmed Bassiouni, Judy Ou, Alkis J. Psaltis, Peter-John Wormald, Sarah Vreugde
Teaser
Capsule Summary: Increased expression of IL-13 is independently affected by the neo-osteogenesis state in CRS. IL-13 protein increased osteoblastic bone mineralization in vitro. Our findings indicate that IL-13 may contribute to pathological bone remodelling in recalcitrant CRS.http://ift.tt/2s0NwxE
B cells control maternofetal priming of allergy and tolerance in a murine model of allergic airway inflammation
Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Christine Happle, Adan Chari Jirmo, Almut Meyer-Bahlburg, Anika Habener, Heinz Gerd Hoymann, Christian Hennig, Jelena Skuljec, Gesine Hansen
BackgroundAllergic asthma is a chronic lung disease resulting from inappropriate immune responses to environmental antigens. Early tolerance induction is an attractive approach for primary prevention of asthma.ObjectiveWe analysed the mechanisms of perinatal tolerance induction to allergens with particular focus on the role of B cells in preconceptional and early intrauterine immune priming.MethodsWild type (WT) and B cell deficient mice received ovalbumin (OVA) intranasally before mating. Their offspring was analysed in a murine model of allergic airway inflammation.ResultsWhile antigen application before conception protected WT progeny from allergy, it aggravated allergic airway inflammation in B cell deficient offspring. B cell transfer restored protection, demonstrating the crucial role of B cells in perinatal tolerance induction. Effective diaplacentar allergen transfer was detectable in pregnant WT mice but not in pregnant B cell KO dams, and antigen concentrations in WT amniotic fluid were higher than in IgG-free amniotic fluid of B cell deficient dams. Application of OVA/IgG immune complexes (IC) during pregnancy boosted OVA uptake by fetal dendritic cells (DCs). Fetal DCs in humans and mice expressed strikingly higher levels of Fcγ receptors compared to DCs from adults and were highly efficient in taking up OVA-IC. Moreover, murine fetal DCs effectively primed antigen-specific foxp3+ Tregs after in vitro coincubation with OVA/IgG containing amniotic fluid.ConclusionOur data support a decisive role for B cells and immunoglobulins during in utero tolerance priming. These findings improve the understanding of perinatal immunity and may support the development of effective primary prevention strategies for allergy and asthma in the future.
Teaser
Maternal allergen application before conception protects murine WT-offspring from allergy but aggravates allergic airway inflammation in B-cell deficient pups. Perinatal tolerance induction is associated with intrauterine antigen/IgG-transfer to fetal DCs which in turn effectively prime antigen-specific Tregs.http://ift.tt/2sYT0Xe
C1q: A fresh look upon an old molecule
Source:Molecular Immunology
Author(s): Nicole M. Thielens, Francesco Tedesco, Suzanne S. Bohlson, Christine Gaboriaud, Andrea J. Tenner
Originally discovered as part of C1, the initiation component of the classical complement pathway, it is now appreciated that C1q regulates a variety of cellular processes independent of complement activation. C1q is a complex glycoprotein assembled from 18 polypeptide chains, with a C-terminal globular head region that mediates recognition of diverse molecular structures, and an N-terminal collagen-like tail that mediates immune effector mechanisms. C1q mediates a variety of immunoregulatory functions considered important in the prevention of autoimmunity such as the enhancement of phagocytosis, regulation of cytokine production by antigen presenting cells, and subsequent alteration in T-lymphocyte maturation. Furthermore, recent advances indicate additional roles for C1q in diverse physiologic and pathologic processes including pregnancy, tissue repair, and cancer. Finally, C1q is emerging as a critical component of neuronal network refinement and homeostatic regulation within the central nervous system. This review summarizes the classical functions of C1q and reviews novel discoveries within the field.
http://ift.tt/2r0aCkK
Intracellular complement − the complosome − in immune cell regulation
Source:Molecular Immunology
Author(s): Giuseppina Arbore, Claudia Kemper, Martin Kolev
The complement system was defined over a century ago based on its ability to "complement" the antibody-mediated and cell-mediated immune responses against pathogens. Today our understanding of this ancient part of innate immunity has changed substantially and we know now that complement plays an undisputed pivotal role in the regulation of both innate and adaptive immunity. The complement system consists of over 50 blood-circulating, cell-surface expressed and intracellular proteins. It is key in the recognition and elimination of invading pathogens, also in the removal of self-derived danger such as apoptotic cells, and it supports innate immune responses and the initiation of the general inflammatory reactions. The long prevailing classic view of complement was that of a serum-operative danger sensor and first line of defence system, however, recent experimental and clinical evidences have demonstrated that "local" tissue and surprisingly intracellular complement (the complosome) activation impacts on normal cell physiology. This review will focus on novel aspects of intracellular complement activation and its unexpected roles in basic cell processes such as metabolism. We also discuss what the existence of the complosome potentially means for how the host handles intracellular pathogens such as viruses.
http://ift.tt/2sjHh91
Intratumoral Fusobacterium nucleatum abundance correlates with macrophage infiltration and CDKN2A methylation in microsatellite-unstable colorectal carcinoma
Abstract
Fusobacterium nucleatum (Fn), a specific species of gut microbiota, has been suggested to be enriched in the microsatellite instability-high (MSI-H) molecular subtype of colorectal carcinomas (CRCs). However, the clinicopathologic and molecular factors that interact with Fn in MSI-H CRCs are poorly understood. In this study, 16S ribosomal RNA gene DNA sequence of Fn was quantitatively measured by real-time polymerase chain reaction in tumor DNA samples from a total of 160 surgically resected MSI-H CRC tissues. Each case was classified into one of the three categories based on the Fn DNA amount: Fn-high, Fn-low, and Fn-negative. The clinicopathologic and molecular associations of Fn in MSI-H CRCs were statistically analyzed. Among the 160 MSI-H CRC samples, 15 (9%), 92 (58%), and 53 (33%) cases were Fn-high, Fn-low, and Fn-negative, respectively. Compared with Fn-low/negative tumors, Fn-high MSI-H CRCs were significantly associated with a high density of CD68+ tumor-infiltrating macrophages (P = 0.019) and promoter CpG island hypermethylation of the CDKN2A (p16) gene (P = 0.008). There were also tendencies toward associations of Fn-high with the BRAF V600E mutation (P = 0.047) and active Crohn-like lymphoid reactions (P = 0.052) in MSI-H CRCs. However, Fn-high was not significantly associated with CD3+ T cell density, CD163+ M2 macrophage density or PD-L1 expression status. In conclusion, high amounts of intratumoral Fn are correlated with increased macrophage infiltration and CDKN2A promoter methylation in MSI-H CRCs.
http://ift.tt/2rFNlXW
Gel-Forming Mucins and Aquaporin Gene Expression in Hearing Problems
This case-control study investigates the association of gel-forming mucins and aquaporin 5 gene expression with inflammation, effusion viscosity, and hearing loss in pediatric otitis media with effusion.
http://ift.tt/2rQ9ql3
http://ift.tt/2rQ9ql3
Cognitive Training Program to Treat Tinnitus
To the Editor The recent randomized clinical trial by Kallogjeri et al on the effect of the Brain Fitness Program-Tinnitus (BFP-T) to treat tinnitus was interesting, but several limitations made me question the conclusions drawn by the authors.
http://ift.tt/2r6wXBb
http://ift.tt/2r6wXBb
Cognitive Training Program to Treat Tinnitus—Reply
In Reply We thank Dr Stevelink for his interest in our work and his comments on our article describing the results of our open-label randomized clinical trial of Brain Fitness Training Program-Tinnitus (BFP-T) for adults with tinnitus. Unfortunately, we believe Dr Stevelink has incorrectly interpreted our study as a study that confirms the effect of BFP-T as a treatment for tinnitus. In our study, we did not observe nor did we conclude there were significant changes in THI and TFI scores associated with the BFP-T intervention. However, 10 of the 20 participants randomized to the BFP-T program self-reported improvement in their tinnitus perception, attention, memory, and concentration, as presented in detail in eTable 2 in Supplement 2. As can be seen in the eTable, the changes on the THI and TFI scores were inconsistent with each other and with subjective responses of perception of change. In our conclusions, we stated that participants endorsed improvements in these domains, suggesting that the computer-based cognitive brain training program is associated with self-reported changes in attention, memory, and perception of tinnitus. We also stated that several specific limitations prevented us from making a definitive conclusion regarding the role of this particular cognitive training program for the treatment of tinnitus.
http://ift.tt/2rQlGCh
http://ift.tt/2rQlGCh
Modified Frailty Index Score and Perioperative Risk in Laryngectomy
This population-based study evaluates use of the Modified Frailty Index in estimation of outcomes in patients undergoing total laryngectomy
http://ift.tt/2r6jZU9
http://ift.tt/2r6jZU9
Patient-Reported Outcome Measures in Upper Airway–Related Dyspnea
This systematic review of upper airway dyspnea–related patient-reported outcome measures evaluates each measure's developmental properties, validation, and applicability.
http://ift.tt/2rQvXOJ
http://ift.tt/2rQvXOJ
Editorial Board
Source:Clinical Immunology, Volume 180
http://ift.tt/2sHxxT4
Leishmaniasis
Zusammenfassung
Das zeitlich verzögerte Auftreten einer Papel nach einem Auslandsaufenthalt kann auf das Vorliegen einer kutanen Leishmaniasis hinweisen. Histologisch zeigt sich eine granulomatöse Entzündungsreaktion, in den Histiozyten findet man in der Giemsa-Färbung intrazelluläre Parasiten. Mittels Polymerasekettenreaktion aus dem Gewebe oder der Kultur lassen sich potenzielle Differenzialdiagnosen ausschließen, aber auch die Leishmania-Subspezies identifizieren. Letzteres ist wichtig für die Wahl des optimalen Therapieregimes.
http://ift.tt/2sHx0Rd
MEN1 mutations and potentially MEN1 -targeting miRNAs are responsible for menin deficiency in sporadic and MEN1 syndrome-associated primary hyperparathyroidism
Abstract
Inherited, germline mutations of menin-coding MEN1 gene cause multiple endocrine neoplasia type 1 (MEN1), while somatic MEN1 mutations are the sole main driver mutations in sporadic primary hyperparathyroidism (PHPT), suggesting that menin deficiency has a central role in the pathogenesis of PHPT. MiRNAs are small, noncoding RNAs posttranscriptionally regulating gene expression. Our aim was to investigate both the role of MEN1 mutations and potentially MEN1-targeting miRNAs as the underlying cause of menin deficiency in MEN1-associated and sporadic PHPT tissues. Fifty six PHPT tissues, including 16 MEN1-associated tissues, were evaluated. Diagnosis of MEN1 syndrome was based on identification of germline MEN1 mutations. In silico target prediction was used to identify miRNAs potentially targeting MEN1. Menin expression was determined by immunohistochemistry while expression of miRNAs was analyzed by quantitative real-time PCR. Sporadic PHPT tissues were subjected to somatic MEN1 mutation analysis as well. Lack of nuclear menin was identified in all MEN1-associated and in 28% of sporadic PHPT tissues. Somatic MEN1 mutations were found in 25% of sporadic PHPTs. The sensitivity and specificity of menin immunohistochemistry to detect a MEN1 mutation were 86 and 87%, respectively. Expression levels of hsa-miR-24 and hsa-miR-28 were higher in sporadic compared to MEN1-associated PHPT tissues; however, no difference in miRNA levels occurred between menin-positive and menin-negative PHPT tissues. Menin deficiency is the consequence of a MEN1 mutation in most menin-negative PHPT tissues. Elevated expression of hsa-miR-24 and hsa-miR-28 mark the first epigenetic changes observed between sporadic and MEN1-associated PHPT.
http://ift.tt/2s09Ffs
Multiple Desmoplastic Cellular Neurothekeomas in Child: Report of the First Oral Case and Review of the Literature
Abstract
Cellular neurothekeomas (CNs) are distinctive benign tumors of uncertain histogenesis, with predilection for the skin of the head and neck region. We describe the first case of multiple desmoplastic CNs (DCNs) affecting the oral cavity in a 9-year-old girl. Histopathologic evaluation showed a proliferation of spindle and epithelioid cells, forming nests and bundles, supported by exuberant fibrous stroma, as well as scattered multinucleated floret-like giant cells. The tumor cells were immunopositive for vimentin, CD63, CD56, whereas AE1/AE3, S100, CD34, α-SMA, GFAP, EMA, CD57 and NSE were negative. Ki-67 was <2%. Multiple DCNs should be considered in the differential diagnosis of oral nodular lesions.
http://ift.tt/2rEN7AD
Malignant hypertension as a rare cause of thrombotic microangiopathy
Malignant hypertension can occasionally be associated with microangiopathic haemolytic anaemia. A 38-year-old male presented with nausea, vomiting, loss of appetite and oliguria for 2 weeks. He was diagnosed with hypertensive emergency with cardiac and renal dysfunction. Interestingly, further workup was diagnostic for the presence of thrombotic microangiopathy (TMA): haemoglobin =12.7 g/dL, indirect bilirubin =2.0 mg/dL, haptoglobin ≤6 mg/dL, platelet count =121 000/μL and schistocytes on peripheral smear. At the outset, the cause of TMA was unclear. Patient denied having diarrhoea, making haemolytic uremic syndrome less likely. A normal ADAMTS13 activity test ruled out thrombotic thrombocytopaenic purpura. Malignant hypertension induced TMA was highest on the differential and plasma exchange was deferred. Renal biopsy revealed features of TMA and malignant nephrosclerosis. Patient eventually became dialysis dependent. Aggressive blood pressure control was obtained with multiple medications.
http://ift.tt/2rPT2kx
Intrahepatic fetus: unusual image of an intratumoural haemorrhage
Description
A 65-year-old man presented to our institution with acute onset, right upper quadrant pain, on a background of rheumatoid arthritis and asthma. He was a lifelong non-smoker, with minimal alcohol consumption and no intravenous drug use. CT and MRI demonstrated a large tumour involving the entire segment IV of the liver positioned between the middle and the left hepatic veins. A T1-weighted axial MRI at the level of right hepatic vein demonstrated an odd, fetus-like lesion within the mass (figure 1). Junior medical staff questioned whether this could be a primary hepatic pregnancy. However, they were reassured that this image portrayed an intraparenchymal bleed, consistent with hepatocellular carcinoma (HCC). A diagnosis of HCC was confirmed by non-invasive criteria for diagnosing HCC recommended by both the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver consensus statement.
http://ift.tt/2r60Sty
Mediastinal seminoma presenting with superior vena cava syndrome
We present a rare cause of superior vena cava syndrome (SVC) in a previously healthy male aged 31 years. Malignancy was suspected due to unintentional weight loss and childhood exposure to radioactive fallout from a nuclear facility accident. A very large anterior mediastinal mass was identified and demonstrated to be an extragonadal seminoma. Extragonadal germ cell tumours are rare tumours with a high potential for cardiovascular, pulmonary and vascular sequelae. Studies have documented an increased risk of developing seminoma in patients with radioactive exposure. Chemotherapy was initiated, during which the patient experienced progressive and new symptoms, found to be due to extensive thromboembolic disease, which responded well to anticoagulation. Seventy-two months after completing chemotherapy, without need for surgical management, he remains free of the disease.
http://ift.tt/2rQ7zgp
Pituitary abscess
Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.
A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone.
Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.
http://ift.tt/2r6cDjA
A case of a chronic salmonella infection following Roux-en-Y gastric bypass surgery, treated successfully by a laparoscopic cholecystectomy
We report a case of chronic infection caused by Salmonella and cured by a laparoscopic cholecystectomy after Roux-en-Y gastric bypass (RYGB) surgery for obesity. This patient presented with a 2-year history of chronic abdominal pain, loose stools and excessive weight loss. Her stool and urine cultures were positive for Salmonella. Despite multiple courses of antibiotics, she remained positive.
After undergoing a laparoscopic cholecystectomy, the patient became asymptomatic and stools remained negative. In chronic carriers for Salmonella, the gall bladder is the common reservoir for the bacteria and removing it is usually curative.
The possibility that the source of the may be in the biliary limb of her bariatric procedure and not in the gall bladder remained a concern.
In patients who have had a RYGB, cholecystectomy is an effective treatment.
All patients presenting with abdominal symptoms following RYGB should have stool and urine cultures taken as part of their work up.
http://ift.tt/2rQ6eGa
Surgical management of isolated mesenteric autoimmune disease: addressing the spectrum of IgG4-related disease and sclerosing mesenteritis
IgG4-related disease (IgG4-RD) is a rare form of autoimmune sclerosing disease, characterised by elevated serum IgG4 and tissue IgG4 levels, specific histopathological findings, multiorgan involvement and adequate response to glucocorticoid treatment. The low incidence and the heterogeneous nature of the disease has made consensus on diagnostic criteria for IgG4-RD difficult. Whether sclerosing mesenteritis (SM) is considered a manifestation of IgG4-RD is strongly debated. We present the case of a patient with a history of rheumatoid arthritis who presented with a calcified abdominal mass. She was found to have an isolated, pedunculated mesenteric mass positive for IgG4 and concurrently elevated serum IgG4 levels. Clinical features did not classify her disease as either SM or IgG4-RD as currently described in consensus statements. Concurrent diagnoses of IgG4-RD, SM and other autoimmune disorders, as well as postoperative recommendations for resected isolated IgG4-positive masses, are discussed.
http://ift.tt/2rPXMqm
Isolated gastric sarcoidosis: a rare entity
We present a case of isolated granulomatous gastritis in a 21-year-old woman. Initial symptoms included nausea, vomiting and inability to tolerate oral intake. An upper oesophagogastroduodenoscopy revealed nodular and thickened mucosa with histological findings of granulomatous gastritis. Infectious, inflammatory and malignant causes were excluded prior to making a diagnosis of gastric sarcoidosis.
http://ift.tt/2r6cCw2
Congenital prepubic sinus (an epispadiac variant of dorsal urethral duplication) with dorsal penile curvature in an adult man: a rare association
Urethral duplication is among a very rare congenital disorder with multiple anatomical variants reported. Urethral duplication of complete type is usually diagnosed during childhood with urinary incontinence or double urinary stream as common presentation. However, patients with incomplete urethral duplication usually present with intermittent mucous discharge from the accessory urethral opening. A 20-year-old man presented to us with intermittent mucous discharge from the accessory opening along with dorsal penile curvature making sexual intercourse very difficult. The epispadiac urethral tract with proximal fibrous tract was excised, and the dorsal penile curvature was corrected by ventral plication, implicating that the fibrous cord may be the causative factor for the development of dorsal curvature.
http://ift.tt/2rPRsiP
Persistent lesion hyperintensity on brain diffusion-weighted MRI is an early sign of intravascular lymphoma
A 63-year-old man presented with right-sided hemianopia and unsteady gait. Brain MRI revealed multiple hyperintense infarct-like lesions on diffusion-weighted images (DWI). Hyperintensity persisted in some of these lesions even after 6 weeks, although his symptoms were ameliorated then. The patient developed episodic dizziness and a transient event of apraxia at 18 weeks after the first episode. Brain MRI revealed additional hyperintense lesions on DWI, which persisted even after 7 weeks. Eventually, the patient manifested cauda equina syndrome 39 weeks after the first episode. Brain MRI showed the presence of new lesions in addition to the persistent hyperintense lesions on DWI over 21 weeks in the right frontal lobe. Based on laboratory findings and the pathological assessment of bone marrow and random skin biopsies, the patient was diagnosed with intravascular lymphoma (IVL). Persistent hyperintense lesions on DWI of brain MRI may precede the clinical exacerbation of IVL.
http://ift.tt/2r5PCgx
Delayed progression of bulls eye maculopathy
Chloroquine-induced maculopathy may progress years after drug cessation and an apparent period of visual stability. Both doctor and patients should be fully aware of the risks of retinal toxicity, including delayed onset and progression. It is therefore crucial that regular monitoring continues in affected patients, long after the initial diagnosis of maculopathy.
http://ift.tt/2rQ6Iwa
Primary myeloid sarcoma of small bowel
Description
A 45-year-old woman presented with severe lower abdominal pain and vomiting. On physical examination, she was found to have tenderness in the suprapubic region and right iliac fossa. An ultrasound abdomen performed to rule out acute appendicitis and pelvic inflammatory disease was not contributory. Blood parameters were within normal limits. As the patient continued to be symptomatic, a contrast-enhanced CT of the abdomen was performed. It revealed eccentric focal bowel wall thickening involving the ileum measuring 3.3x2.4 cm, with homogeneous enhancement on postcontrast images causing mild luminal compromise (figures 1, figure 2). Oral contrast was noted to pass distally with no proximal hold-up. Mild dilatation of proximal ileal loops with diffuse wall thickening was noted (figure 3). No perifocal mesenteric fat infiltration was identified. Few discrete enlarged perifocal lymph nodes were noted (figure 4). There was no retroperitoneal lymphadenopathy. In view of...
http://ift.tt/2r5T6zL
Port site recurrence after laparoscopic radical nephrectomy: a case report
Due to the recent development of laparoscopic devices, laparoscopic radical nephrectomy is the standard procedure for localized renal cell carcinoma. However, some studies have reported postoperative port site...
http://ift.tt/2sH1oeq
Role of Panoramic Imaging and Cone Beam CT for Assessment of Inferior Alveolar Nerve Exposure and Subsequent Paresthesia Following Removal of Impacted Mandibular Third Molar
Abstract
Objectives
Pre-operative radiographic evaluation of impacted mandibular third molar and inferior alveolar canal (IAC) is important in preventing a possible nerve exposure and damage during surgical removal. The present study analysed the relation of the mandibular third molar with inferior alveolar canal using panoramic radiography (PAN) and cone beam CT (CBCT) and evaluated the radiographic features suggestive of IAN exposure and post-operative paresthesia.
Materials and Methods
PAN and CBCT findings of 53 impacted mandibular third molars having a close relation with IAC undergoing extraction were analysed. Further, all cases were evaluated for any sensory loss in relation to IAN 1 week post-operatively.
Results
The most common PAN feature was combination of darkening of roots (DR) and interruption of white line (IWL), seen in 35.86% (19) cases. The most common CBCT feature was thinning of lingual cortex in 81.14% (43) cases. The most common location of IAC in CBCT was inferior in 47.16% (25) cases, followed by buccal 26.41% (14). On comparison of PAN and CBCT findings, DR and IWL both exclusively 92.86% (13); 80% (12) cases and in combination 75% (15) were most commonly associated with thinning of lingual cortex. IAN exposure was seen in 7.55% (4) cases, and 3.77% (2) cases reported with paresthesia. Absence of corticalisation and IWL was associated with all cases of nerve exposure, inter-radicular location of IAC seen in three out of the four cases. Cases with paresthesia had DR and deflection of roots (DEFR) with thinning of lingual cortex by roots.
Conclusion
DR with DEFR or IWL in PAN as combination and inter-radicular location of IAC with thinning of lingual cortex by root tips in CBCT are highly predictive of nerve exposure and subsequent paresthesia.
http://ift.tt/2sHvWwI
Multiple Desmoplastic Cellular Neurothekeomas in Child: Report of the First Oral Case and Review of the Literature
Abstract
Cellular neurothekeomas (CNs) are distinctive benign tumors of uncertain histogenesis, with predilection for the skin of the head and neck region. We describe the first case of multiple desmoplastic CNs (DCNs) affecting the oral cavity in a 9-year-old girl. Histopathologic evaluation showed a proliferation of spindle and epithelioid cells, forming nests and bundles, supported by exuberant fibrous stroma, as well as scattered multinucleated floret-like giant cells. The tumor cells were immunopositive for vimentin, CD63, CD56, whereas AE1/AE3, S100, CD34, α-SMA, GFAP, EMA, CD57 and NSE were negative. Ki-67 was <2%. Multiple DCNs should be considered in the differential diagnosis of oral nodular lesions.
http://ift.tt/2rEN7AD
Effect of cochlear implant surgery on vestibular function: meta-analysis study
Abstract
Importance
Vestibular disorders have been reported following cochlear implant (CI) surgery, but the literature shows a wide discrepancy in the reported clinical impact. The aim of this meta-analysis is to quantify the effect of CI before and after surgery on the outcomes of vestibular tests, postural stability, and subjective perception of dizziness.
Objective
To evaluate the effects of CI surgery on vestibular function in adult patients (≥18 years) with sensorineural hearing loss who underwent unilateral or bilateral implantation.
Data sources
MEDLINE, PubMed, Web of Science and Cochrane Library from January 1, 1995, through July 12, 2016.
Study selection
Published studies of adult patients who received unilateral or bilateral CIs and whose vestibular function or postural stability was assessed before and after surgery.
Data extraction
From each study, test results before and after surgery were compared, for the following five tests: clinical head impulse test (HIT); bi-thermal caloric irrigation of the horizontal semicircular canal; vestibular evoked myogenic potential (VEMP); dizziness handicap inventory (DHI); and computerized dynamic posturography (CDP).
Results
Twenty-seven studies met all inclusion criteria. Most studies performed either bi-thermal caloric irrigation and/or VEMP, with fewer studies investigating changes in HIT, posturography or DHI. CI surgery significantly affected the results of caloric and VEMP testing. However, HIT results, posturography, and DHI, scores were not significantly affected after CI surgery.
Conclusions and relevance
CI surgery has a significant negative effect on the results of caloric as well as VEMP tests. No significant effect of CI surgery was detected in HIT, posturography, or DHI scores. Overall, the clinical effect of CI surgery on the vestibular function was found to be insignificant. Nonetheless, the potential effects of surgery on the vestibular system should be discussed with CI candidates before surgery.
http://ift.tt/2sHj2Pg
Multiple Desmoplastic Cellular Neurothekeomas in Child: Report of the First Oral Case and Review of the Literature
Abstract
Cellular neurothekeomas (CNs) are distinctive benign tumors of uncertain histogenesis, with predilection for the skin of the head and neck region. We describe the first case of multiple desmoplastic CNs (DCNs) affecting the oral cavity in a 9-year-old girl. Histopathologic evaluation showed a proliferation of spindle and epithelioid cells, forming nests and bundles, supported by exuberant fibrous stroma, as well as scattered multinucleated floret-like giant cells. The tumor cells were immunopositive for vimentin, CD63, CD56, whereas AE1/AE3, S100, CD34, α-SMA, GFAP, EMA, CD57 and NSE were negative. Ki-67 was <2%. Multiple DCNs should be considered in the differential diagnosis of oral nodular lesions.
http://ift.tt/2rEN7AD
Vertical bone regeneration using rhBMP-2 and VEGF
Sufficient vertical and lateral bone supply and a competent osteogenic healing process are prerequisities for the successful osseointegration of dental implants in the alveolar bone. Several techniques includi...
http://ift.tt/2s7tgeK
Atezolizumab Combinations With Chemotherapy for Anaplastic and Poorly Differentiated Thyroid Carcinomas
Conditions: Malignant Neoplasms of Thyroid and Other Endocrine Glands; Anaplastic Thyroid Carcinoma; Poorly Differentiated Thyroid Cancer
Interventions: Drug: Nab-paclitaxel - INDUCTION COHORT; Drug: Paclitaxel - INDUCTION COHORT; Drug: Vemurafenib - COHORT 1; Drug: Cobimetinib - COHORT 1; Drug: Atezolizumab - COHORT 1; Drug: Bevacizumab - COHORT 3; Drug: Nab-paclitaxel - COHORT 4; Drug: Paclitaxel - COHORT 4; Drug: Cobimetinib - COHORT 2; Drug: Atezolizumab - COHORT 2; Drug: Atezolizumab - COHORT 3; Drug: Atezolizumab - COHORT 4
Sponsors: M.D. Anderson Cancer Center; Genentech, Inc.
Not yet recruiting - verified June 2017
http://ift.tt/2rZvJXL
Interventions: Drug: Nab-paclitaxel - INDUCTION COHORT; Drug: Paclitaxel - INDUCTION COHORT; Drug: Vemurafenib - COHORT 1; Drug: Cobimetinib - COHORT 1; Drug: Atezolizumab - COHORT 1; Drug: Bevacizumab - COHORT 3; Drug: Nab-paclitaxel - COHORT 4; Drug: Paclitaxel - COHORT 4; Drug: Cobimetinib - COHORT 2; Drug: Atezolizumab - COHORT 2; Drug: Atezolizumab - COHORT 3; Drug: Atezolizumab - COHORT 4
Sponsors: M.D. Anderson Cancer Center; Genentech, Inc.
Not yet recruiting - verified June 2017
http://ift.tt/2rZvJXL
Maintenance Therapy of Apatinib After Chemoradiotherapy in Nasopharyngeal Carcinoma With Metastasis
Condition: Nasopharyngeal Neoplasms
Intervention: Drug: Apatinib
Sponsors: Sichuan Cancer Hospital and Research Institute; Jiangsu HengRui Medicine Co., Ltd.
Recruiting - verified June 2017
http://ift.tt/2sXdP51
Intervention: Drug: Apatinib
Sponsors: Sichuan Cancer Hospital and Research Institute; Jiangsu HengRui Medicine Co., Ltd.
Recruiting - verified June 2017
http://ift.tt/2sXdP51
The Study of Early Stage Osteonecrosis of Femoral Head With Human Umbilical Cord Mesenchymal Stem Cells
Condition: Osteonecrosis of Femoral Head
Interventions: Drug: Allogeneic umbilical cord mesenchymal stem cells (SCLnow 19#); Procedure: core decompression
Sponsor: Sclnow Biotechnology Co., Ltd.
Not yet recruiting - verified May 2017
http://ift.tt/2rZtB2j
Interventions: Drug: Allogeneic umbilical cord mesenchymal stem cells (SCLnow 19#); Procedure: core decompression
Sponsor: Sclnow Biotechnology Co., Ltd.
Not yet recruiting - verified May 2017
http://ift.tt/2rZtB2j
Correlation of FAZA PET Hypoxia Imaging To 3D Histology in Oral Tongue Cancer
Condition: Tongue Cancer
Interventions: Radiation: (18)F-Fluoroazomycin arabinoside; Drug: Pimonidazole
Sponsors: Sunnybrook Health Sciences Centre; Sunnybrook Research Institute; University of Toronto
Not yet recruiting - verified June 2017
http://ift.tt/2rZtALN
Interventions: Radiation: (18)F-Fluoroazomycin arabinoside; Drug: Pimonidazole
Sponsors: Sunnybrook Health Sciences Centre; Sunnybrook Research Institute; University of Toronto
Not yet recruiting - verified June 2017
http://ift.tt/2rZtALN
Spectrum of genetic mutations in de novo PUNLMP of the urinary bladder
Abstract
Our group and others have previously demonstrated the presence of TERT promoter mutations (TERT-mut) in 60–80% of urothelial carcinomas and some of their histologic variants. Five other genes have been frequently implicated in bladder cancer: FGRF3, TP53, PIK3CA, HRAS, and CDKN2A. In the current study, we sought to determine the prevalence of mutations in TERT and these five other genes in de novo papillary urothelial neoplasms of low malignant potential (PUNLMP) of the urinary bladder. A retrospective search of our archives for PUNLMP was performed and 30 de novo cases were identified and included in the study. We found mutations in TERT (TERT-mut) and FGFR3 (FGFR3-mut) to be the most common alterations in the cohort (63 and 60%, respectively). The majority of the TERT-mut-positive tumors (84%) had a g.1295228C > T alteration with the remaining tumors demonstrating g.1295250C > T. Approximately one fourth of tumors had TP53 mutations. These findings support the potential utility of a uniform genetic mutation panel to detect bladder cancers of various subtypes.
http://ift.tt/2sXOLea
Oral Manifestations of Viral Infections
Publication date: Available online 7 June 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Mahnaz Fatahzadeh
http://ift.tt/2rPIrpX
Cellular and molecular pathways of structural damage in rheumatoid arthritis
Abstract
Structural damage of cartilage and bone tissue is a hallmark of rheumatoid arthritis (RA). The resulting joint destruction constitutes one of the major disease consequences for patients and creates a significant burden for the society. The main cells executing bone and cartilage degradation are osteoclasts and fibroblast-like synoviocytes, respectively. The function of both cell types is heavily influenced by the immune system. In the last decades, research has identified several mediators of structural damage, ranging from infiltrating immune cells and inflammatory cytokines to autoantibodies. These factors result in an inflammatory milieu in the affected joints which leads to an increased development and function of osteoclasts and the transformation of fibroblast-like synoviocytes towards a highly migratory and destructive phenotype. In addition, repair mechanisms mediated by osteoblasts and chondrocytes are strongly impaired by the presence of pro-inflammatory cytokines. This article will review the current knowledge on the mechanisms of joint inflammation and the destruction of bone and cartilage.
http://ift.tt/2rZhylE
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