Head and Neck Medicine by Alexandros G.Sfakianakis: 06/09/17

Παρασκευή 9 Ιουνίου 2017

Diagnostic performance of 18fluorodesoxyglucose positron emission/computed tomography and magnetic resonance imaging in detecting T1-T2 head and neck squamous cell carcinoma

Objectives/Hypothesis

The aim of this study was to assess and compare the diagnostic accuracy of ¹⁸fluorodesoxyglucose positron emission/computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) to detect T1-T2 head and neck squamous cell carcinoma (HNSCC).

Study Design

Prospective case series.

Methods

Thirty-five consecutive patients with histologically proven T1-T2 HNSCC were prospectively included. All patients underwent pretherapeutic FDG-PET/CT and MRI. Two nuclear medicine physicians and 2 radiologists blindly reviewed all FDG-PET/CT and MRI, respectively. A five-point qualitative scale was used to estimate tumor detection ability. Sensitivity of each modality was compared together using a McNemar test. Interobserver variability was assessed by kappa index (κ) of Cohen statistics. Maximal standardized uptake value (SUV_MAX), metabolic tumor volume (MTV) in FDG-PET/CT, and gadolinium enhancement (%GE) in MRI of each tumor were recorded and compared with T stage using a Mann-Whitney test. Tumor-to-normal tissue ratios in FDG-PET/CT and MRI (TNR_PET and TNR_MRI) were calculated and compared together using a Student t test.

Results

Among the 35 primary tumors, 29 were detected by FDG-PET/CT and 22 by MRI. MRI detected none of the six lesions incorrectly identified by FDG-PET/CT. FDG-PET/CT correctly identified seven of the 13 MRI false-negative results. Sensitivity of FDG-PET/CT to detect T1-T2 HNSCC was significantly higher than MRI (83% vs. 63%, P = .015). T stage was significantly correlated with MTV (P = .002) unlike with SUV_MAX (P = .06) and %GE (P = .70). TNR_PET was significantly higher than TNR_MRI (3.5 ± 3.2 vs. 1.2 ± 0.3, P < .0001).

Conclusions

Our study showed a higher diagnostic accuracy of FDG-PET/CT than MRI to detect T1-T2 HNSCC with a good interobserver agreement.

Level of Evidence

4 Laryngoscope, 2017

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Can the Ni classification of vessels predict neoplasia? A systematic review and meta-analysis

Objectives

The Ni classification of vascular change from 2011 is well documented for evaluating pharyngeal and laryngeal lesions, primarily focusing on cancer. In the planning of surgery it may be more relevant to differentiate neoplasia from non-neoplasia. We aimed to evaluate the ability of the Ni classification to predict laryngeal or hypopharyngeal neoplasia and to investigate if a changed cutoff value would support the recent European Laryngological Society (ELS) proposal of perpendicular vascular changes as indicative of neoplasia.

Data Sources

PubMed, Embase, Cochrane, and Scopus databases.

Review Methods

A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched for publications from 2011 until 2016. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of the Ni classification with two different cutoffs were calculated, and bubble and summary receiver operating characteristics plots were created.

Results

The combined sensitivity of five studies (n = 687) with Ni type IV-V defined as test-positive was 0.89 (95% confidence interval [CI]: 0.76-0.95), and specificity was 0.82 (95% CI: 0.72-0.89). The equivalent combined sensitivity of four studies (n = 624) with Ni type V defined as test-positive was 0.82 (95% CI: 0.75-0.87), and specificity was 0.93 (95% CI: 0.82-0.97).

Conclusions

The diagnostic accuracy of the Ni classification in predicting neoplasia was high, without significant difference between the two analyzed cutoff values. Implementation of the proposed ELS classification of vascular changes seems reasonable from a clinical perspective, with comparable accuracy. Attention must be drawn to the accompanying risk of exposing patients to unnecessary surgery. Laryngoscope, 2017

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Social media presence of otolaryngology journals: The past, present, and future

Objectives/Hypothesis

Evaluate the use of Twitter by otolaryngology journals and determine the relationship between social media altmetrics and measures of academic impact.

Study Design

Cross-sectional analysis.

Methods

Twitter profiles from the top 50 otolaryngology journals per 2016 SCImago Journal & Country Rank (SJR) were included. Twitter activity for each profile was calculated using Twitonomy analytics and Riffle software. Social media influence was measured using Klout scores. Annual SJR rank and H-Index scores between 2008 and 2016 were recorded for each journal. Associations between social media influence and academic indices were assessed using Wilcoxon rank sum test, Spearman's rank order test, and Pearson correlation coefficients (α = .05).

Results

Average SJR was 0.86 ± 0.3 and H-Index was 50.9 ± 24. Eighteen journals had Twitter profiles. Journals with social media accounts had significantly higher SJR (P = .03) and H-Index (P = .01) scores compared to those without. The average Klout score of Twitter profiles was 32.5 ± 13. There was a significant association between a journal's Klout score and SJR rank (P = .004). Older Twitter profiles had higher Klout scores (P = .04). There was a direct relationship between a journal's total Twitter followers and H-Index score (P = .009), and a direct relationship between tweets and academic influence (P = .03 and .01 for SJR and H-Index, respectively).

Conclusions

Social media is often underutilized and remains an untapped resource by many journals to increase readership and disseminate research. Journals with social media profiles had significantly higher academic metrics, and among journals with profiles, increased online activity was a predictor for academic influence. Future studies are warranted to elucidate causal relationships.

Level of Evidence

NA Laryngoscope, 2017

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What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis

Objectives/Hypothesis

Previous studies have shown declines in productivity due to chronic rhinosinusitis (CRS) are correlated with disease-specific quality-of-life (QOL) measures. However, it is unclear which symptom domains contribute primarily to productivity loss. This investigation sought to assess the association between CRS-specific QOL subdomain impairment and productivity loss.

Study Design

Prospective, multi-institutional, observational cohort study.

Methods

There were 198 patients with refractory CRS enrolled between August 2012 and June 2015. Baseline QOL measures were obtained across five subdomains of the 22-item SinoNasal Outcome Test (SNOT-22). Lost productivity time was determined from patient-reported measures of annual absenteeism, presenteeism, and lost leisure time, and then monetized using annual daily wage rates from the 2012 US National Census and 2013 Department of Labor statistics.

Results

Productivity losses correlated with impairments in both SNOT-22 psychological dysfunction (Spearman correlation coefficient [Rs] = 0.428, P < .001), and sleep dysfunction domain scores (Rs = 0.355, P < .001). Higher SNOT-22 total scores also significantly correlated with increased monetized productivity losses (Rs = 0.366, P < .001). The mean annual productivity cost was $11,820/patient, whereas patients with comorbid immunodeficiency ($23,285/patient), tobacco use ($23,195/patient), and steroid dependency ($18,910/patient) reported higher than average annual productivity costs. Multivariate linear regression found maximum annual productivity costs in adjusted psychological ($13,300/patient, P < .001) and sleep dysfunction ($9,275/patient, P < .001) domains.

Conclusions

Impairments in sleep and psychological SNOT-22 domains correlate with productivity losses. Patients with comorbid immunodeficiency, smoking, and steroid dependency had higher than average productivity losses. Targeted management of psychological and sleep dysfunction in combination with standard symptom control may improve patient-centered care and reduce the annual economic burden of CRS.

Level of Evidence

2c Laryngoscope, 2017

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Intermittent compressive stress regulates Notch target gene expression via transforming growth factor-β signaling in murine pre-osteoblast cell line

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Jeeranan Manokawinchoke, Prasit Pavasant, Thanaphum Osathanon
ObjectiveDifferent mechanical stimuli regulate behaviors of various cell types, including osteoblasts, osteocytes, and periodontal ligament fibroblasts. Notch signaling participates in the mechanical stress-regulated cell responses. The present study investigated the regulation of Notch target gene and sclerostin (Sost) expression in murine pre-osteoblast cell line (MC3T3-E1) under intermittent compressive stress.MethodsMC3T3-E1 were subjected to the intermittent compressive force under the computerized controlled machine. In some experiments, cells were pretreated with chemical inhibitors for Notch and transforming growth factor (TGF)-β signaling prior to mechanical stimuli. To evaluate role of Notch signaling in MC3T3-E1 cells under unloaded condition, cells were seeded on indirect immobilized Notch ligand (Jagged1). Gene expression was determined using real-time quantitative polymerase chain reaction.ResultsThe intermittent compressive stress significantly upregulated Notch target gene expression (Hes Family BHLH transcription factor 1; Hes1 and Hairy/enhancer-of-split related with YRPW motif protein1; Hey1). The intermittent stress-induced Hes1 and Hey1 mRNA expression could be inhibited by a γ-secretase inhibitor (DAPT) or a TGF-β superfamily type I activing receptor-like kinase receptors inhibitor (SB431542). The results imply that intermittent compressive stress regulates Notch signaling via TGF-β pathway. Further, the intermittent compressive stress reduced Sost mRNA expression and this phenomenon could be rescued by a DAPT pretreatment, implying the involvement of Notch signaling. However, activation of Notch signaling under the unloaded condition resulted in the increase of Sost expression and the reduction of osteogenic marker genes.ConclusionsThese results imply the involvement of Notch signaling in the homeostasis maintaining of osteogenic cells under mechanical stress stimuli.

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Effect of 1.2% of simvastatin gel as a local drug delivery system on Gingival Crevicular Fluid interleukin-6 & interleukin-8 levels in non surgical treatment of chronic periodontitis patients

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Gayathri Gunjiganur Vemanaradhya, Shilpa Emani, Dhoom Singh Mehta, Shilpy Bhandari
AimThe present study was carried out to evaluate the effect of 1.2% simvastatin gel as local drug delivery (LDD) system on Gingival Crevicular Fluid (GCF) Interleukin -6 (IL-6) and Interleukin-8 (IL-8) levels in chronic periodontitis patients, in addition to scaling and root planing (SRP).MethodsA total of 46 chronic periodontitis patients were equally divided into two groups. Group I patients were treated by SRP; Group II patients were treated by SRP followed by LDD of 1.2% simvastatin (SMV) gel. Plaque index (PI), Gingival index(GI), Sulcus Bleeding Index (SBI), Probing pocket depth (PPD) and Relative clinical attachment level (CAL) were recorded & GCF samples were collected at baseline (0day) and at 45th day from both the groups. The collected GCF samples were analysed for IL-6 and IL-8 levels with enzyme-linked immunosorbent assay (ELISA).ResultsBoth the groups showed significant reduction in all the clinical parameters scores and IL-6 and IL-8 levels after non-surgical periodontal therapy (SRP for group I/SRP+1.2% SMV gel for group II) in contrast to baseline values. However, a greater reduction was observed in group II. A non-significant positive correlation was observed between clinical parameters and IL-6 and IL-8 levels except at baseline, a significant correlation was observed between PPD &IL 6 levels in group II.ConclusionsIn adjunct to SRP, 1.2% Simvastatin gel acts as an effective local drug delivery agent for the management of chronic periodontitis.

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Effect of interocclusal appliance on bite force, sleep quality, salivary cortisol levels and signs and symptoms of temporomandibular dysfunction in adults with sleep bruxism

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): João Vicente Rosar, Taís de Souza Barbosa, Ilo Odilon Villa Dias, Fernanda Yukie Kobayashi, Yuri Martins Costa, Maria Beatriz Duarte Gavião, Leonardo Rigoldi Bonjardim, Paula Midori Castelo
ObjectiveThe purpose was to evaluate the effect interocclusal appliance therapy on bite force (BF), sleep quality and salivary cortisol levels in adults with SB diagnosed by polysomnography. As a secondary aim, signs and symptoms of temporomandibular dysfunction (TMD) were evaluated.DesignForty-three adults (19–30 y/o) were divided into two groups: experimental group (GSB), composed of 28 subjects with SB, and control group (GC), without SB and TMD (n=15). GSB was treated with stabilization interocclusal splint and evaluated at time intervals: before (baseline), one month (T1) and two months (T2) after therapy began, to collect data related to BF, sleep quality (Pittsburgh Sleep Quality Index), salivary cortisol levels and TMD. GC was also examined three times and received no therapy. Data were analysed by means of normality tests, t-test/Mann-Whitney and One-way ANOVA repeated measures (Tukey post-test). Two-way ANOVA test for repeated measures was applied to verify the effect time*group interaction on the variance of each dependent variable (α=0.05).ResultsGSB showed an increase in BF and a positive effect on muscular symptomatology, range of mandibular movements and sleep quality; in GC these parameters did not differ. Cortisol concentration decreased between baseline and T1 in GSB (F(1,31)=4.46; test power=62%; p=0.017). The variance observed for BF, TMD and sleep quality among time points was dependent on the group (moderate effect size: partial Eta square >0.16; test power >80%).ConclusionsThe results suggested that short-term interocclusal appliance therapy had a positive effect on BF, temporomandibular symptomatology, sleep quality and salivary cortisol levels in adults with SB.

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Intermittent compressive stress regulates Notch target gene expression via transforming growth factor-β signaling in murine pre-osteoblast cell line

Effect of 1.2% of simvastatin gel as a local drug delivery system on Gingival Crevicular Fluid interleukin-6 & interleukin-8 levels in non surgical treatment of chronic periodontitis patients

Effect of interocclusal appliance on bite force, sleep quality, salivary cortisol levels and signs and symptoms of temporomandibular dysfunction in adults with sleep bruxism

Interaction of Immunoglobulin with Cytomegalovirus-Infected Cells

Viral Immunology , Vol. 0, No. 0.

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Titanium incus interposition ossiculoplasty: audiological outcomes and extrusion rates

Abstract

This study aimed to evaluate the benefit but also the extrusions, dislocations, and failures of a titanium incus prosthesis along with the long-term audiological outcomes. We prospectively collected data from 139 patients undergoing ossiculoplasty using the Fisch titanium incus prosthesis between 2001 and 2016. Overall, 126 patients with at least 6 months of follow-up (mean 4.5 years, range 6–155 months) were analyzed. Patients were grouped as "extrusion" (n = 9, 7%) if the prosthesis extruded, "failure" (n = 22, 18%) if a reoperation was needed concerning the prosthesis, and "stable" (n = 95, 75%) if the prosthesis remained functional in the middle ear. Mean postoperative air bone gaps (ABG) for 0.5–3 kHz for the overall group and the stable group were 19.8 (±11.9) and 15.3 (±7.5), respectively. Long-term results of stable group revealed an ABG (0.5–3 kHz) below 10 dB in 25% and below 20 dB in 81% of the patients. Atelectasis was the most frequent cause of extrusion, which occurred after a mean time of 28.7 months (range 15–48 months). Mean timing for reoperation was 30.7 months (range 5–131 months) in the failure group. There was no significant difference in mean postoperative ABG among patients with or without cholesteatoma, primary or staged ossiculoplasty in cholesteatoma, presence or absence of malleus head at the time of ossiculoplasty, open or closed cavity surgeries, or the degree of pneumatization of the temporal bone. The Fisch titanium incus prosthesis is a reliable alternative to using autologous incus for interposition ossiculoplasty, with similar hearing outcomes. Using this prosthesis, a 15 dB ABG should be expected.

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Early stage minor salivary gland adenoid cystic carcinoma has favourable prognosis

Abstract

The purpose of the study was to evaluate the long-term outcome of minor salivary and mucous gland (MiSG) adenoid cystic carcinoma (ACC) of the head and neck and to compare the results with earlier reports including our recently published series on major salivary gland (MaSG) ACC. The study comprised 68 MiSG ACCs operated during 1974–2012 at the Helsinki University Hospital, Helsinki, Finland. Medical records and histological samples were reviewed. Our previously published cohort comprising 54 MaSG ACCs during the years from 1974 to 2009 was used for comparison. The most common locations were the oral cavity and sinonasal cavities. Most patients presented stages IV (33.8%) and I (23.5%) disease. Primary treatment with curative intent, mainly surgery, was offered for 64 patients. Thirty-three (51.6%) of these patients developed a disease recurrence and 22 (66.7%) patients in less than 5 years. The difference in the length of recurrence-free time (<5 vs. >5 years) had an impact on OS and DSS (p < 0.001) showing worse prognosis for the earlier recurring group. T classes 2–4 (p = 0.005, p < 0.001, and p = 0.001, respectively) and stages II–IV (p = 0.019, p < 0.001, and p = 0.002, respectively) were associated with worse OS, DSS, and DFS. MiSG ACC had a similar long-term survival compared to MaSG ACC. Patients with stage I MiSG ACC seem to carry a favourable prognosis compared with those with stages II, III, and IV tumours. It is thus noteworthy that stage II tumours represent a truly advanced disease entity warranting a more aggressive treatment approach.

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Ptosis as a complication of Kawasaki disease

Kawasaki disease is an acute febrile exanthematous disease that affects children younger than 5 years of age. It is regarded as the most common cause of childhood acquired heart disease, but ocular and neurological problems are among the other important clinical findings. We present a 3-year-old boy who developed bilateral ptosis on day 21, 5 days after intravenous immunoglobulin. The ptosis was due to bilateral paralysis of the levator palpebrae superioris muscles and resolved spontaneously on day 25. There were no cardiac sequelae.

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Extensive cutaneous involvement due to herpes simplex virus infection

Description

A 39-year-old woman, with a medical history of oligofrenia, obesity and varicella at 8 years of age, presented to the emergency department (ED) with multiple skin lesions of upper limb, which began with the appearance of vesicles, associated with intense pain and pruritus and with 3 days of evolution. No fever was reported. She was discharged home medicated with acyclovir and hydroxyzine.

Three days later, she returned to the ED with worsening complaints of pain and itching, and extension of cutaneous lesions throughout the body.

On physical examination, she was febrile (T: 38.5°C), with erythematous-pruriginous lesions, some of which were typically targeted, associated with numerous bullae dispersed throughout the body with oral mucosa involvement (figure 1A–C).

Figure 1

(A) Erythematous lesions associated with numerous bullae dispersed throughout the right upper limb. (B) Erythematous lesions associated with numerous bullae dispersed throughout the left upper limb. (C) Erythematous lesions some of which were...

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A rare case of Ludwigs angina after viper bite

Description

A previously healthy 20-year-old woman presented to our Accident and Emergency Department of Degehbur Hospital, a small district hospital in Somali region of Ethiopia, with complaints of rapidly progressive swelling in her neck and difficulty in swallowing for the past 2 days (figures 1 and 2). She was bitten by a snake, which was later identified as a viper, over her right lower jaw while sleeping on the floor. She did not seek any medical treatment until day 3 when the swelling became worse and involved both submandibular region and the tongue. She also complained of rapidly increase shortness of breath for the past 24 hours.

Figure 1

The patient presented to emergency department with severe swelling of her tongue, neck and submandibular area.

Figure 2

Lateral view of the patient showing severe submandibular swelling that obscuring the airway.

...

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Diagnosis and following up of Ménière’s disease using multifrequency tympanometry—Cutoff values and temporal changes in measurements

Publication date: Available online 9 June 2017
Source:Auris Nasus Larynx
Author(s): Kazuyuki Ishizu, Akihiro Tamae, Kazuhiko Kubo, Takamasa Yoshida, Nozomu Matsumoto, Tetsurou Yasui, Takashi Nakagawa
ObjectiveThis 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.MethodsThe study included 51 patients with clinically diagnosed MD, who had not undergone endolymphatic sac surgery, but had no other known ear disease (57 ears in patients aged 22–80 years were affected, and 45 ears in patients aged 18–83 years were unaffected; mean age: 53.3±16.9 years). We also enlisted 80 healthy controls with no prior history of ear disease (160 ears, aged 22–76 years, mean age: 40.8±15.7 years). MFT was used to measure the bimodal peak width of the waveform obtained when measuring conductance at resonance frequency of 2000Hz. For patients who had G width measured several times over multiple outpatient visits, we used initial test data to analyze cutoff values. In nine cases with four or more measurements over time, we evaluated a possible correlation between G width and the sum of the hearing threshold for three low-pitched frequencies (125Hz, 250Hz, and 500Hz). We used Student's t-test to determine significance.ResultsThe both ears in the MD patients had a G width wider than the distribution in the control group. There was a significant difference between G width in the control group and in affected ears with MD (p=0.00026) and there was also a significant difference between G width in the control group and in unaffected ears of MD patients (p=0.0056). The cutoff value set with a specificity of 95% was 200daPa, with a sensitivity of 35.1% and specificity of 95.6%. The cutoff value set with a sensitivity of 50% was 140daPa, with sensitivity of 50.9% and specificity of 78.8%. There was no significant difference between resonance frequency of ears in the control group and ears with MD (p=0.41). In nine cases with four or more measurements over time, a case showed a statistically significant positive correlation between the G width and hearing ability threshold for low-pitched sounds (125Hz, 250Hz, and 500Hz) (p=0.03), while an another case showed a tendency toward a positive correlation, which was not statistically significant (p=0.08). Further, there were cases that did not show significant differences in the present study, but might have shown a negative correlation if the number of measurements had been increased.ConclusionMeasurement of G width using MFT may have accuracy as the traditional endolymphatic hydrops test. MFT is non-invasive, causes little discomfort for patients, requires little time to perform, and can be performed by paramedics. MFT was shown to be useful in screening for MD and it is effective in diagnosing MD to measure the change over time of G width using MFT.

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Editorial Board

Publication date: October 2017
Source:Auris Nasus Larynx, Volume 44, Issue 5

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The Use of Intracranial Doppler as a Cause for Intraoperative Hyperthermia

No abstract available

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Effects of an Intraoperative Dexmedetomidine Bolus on the Postoperative Blood Pressure and Pain Subsequent to Craniotomy for Supratentorial Tumors

Background: Control of emergence hypertension and pain is important after craniotomy for monitoring the neurological status. This prospective double-blinded study investigated the hemodynamics after a single bolus of dexmedetomidine (DEX) infusion administered to the patient undergoing craniotomy under general anesthesia, and its effect on emergence hypertension and postsurgical pain. Methods: Adult patients scheduled for elective surgery for supratentorial tumors were randomized to receive a 10-minute intraoperative DEX infusion of 0.4 μg/kg (small dose, n=43) or 0.8 μg/kg (medium dose, n=46), or normal saline (vehicle control, n=45), ∼60 minutes before the end of anesthesia. Results: A transient increase in the blood pressure associated with DEX was observed; 53.5% and 91.3% of the patients in the small-dose and the medium-dose groups, respectively, required treatment. Emergence mean arterial pressure and heart rates were significantly lower in the DEX groups compared with the control group. Incidence rates of postoperative hypertension in the small-dose (16.3%) and the medium-dose groups (15.2%) were significantly lower relative to that of the control group (35.6%). Patients who received DEX had a lower Verbal Numerical Rating Scale (VNRS) score in the neurosurgical ICU than the control group, and postsurgical pain (VNRS≥4) was lower in the medium-dose group (41.3%) than in the control group (71.1%). No shivering was observed in the medium-dose group, which was significantly less than that of the other 2 groups. Conclusions: An intraoperative bolus of DEX risks a transient increase in mean arterial pressure, but controls emergence hypertension effectively. Dose-related reductions in postsurgical pain and shivering were observed.

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Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains.

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Effects of Acupuncture in Anesthesia for Craniotomy: A Meta-Analysis

Background: Acupuncture treatment has been used in China for >2500 years, and at present it is used worldwide as a form of analgesia in patients with acute and chronic pain. Furthermore, acupuncture is regularly used not only as a single anesthetic technique but also as a supplement or in addition to general anesthesia (GA). Objectives: The aim of this systematic review and meta-analysis was to assess the level of evidence for the clinical use of acupuncture in addition to GA in patients undergoing craniotomy. Design: This is a systematic review of randomized controlled trials with meta-analyses. Data Sources: The literature search (PubMed, Cochrane Library, and Web of Science) yielded 56 citations, published between 1972 and March 01, 2015. No systematic review or meta-analyses on this topic matched our search criteria. Each article of any language was assessed and rated for the methodological quality of the studies, using the recommendation of the Oxford Centre for Evidence Based Medicine. Ten prospective randomized controlled clinical trials with a total of 700 patients were included. Eligibility Criteria: Included in the meta-analysis were studies that involved any craniotomy under GA compared with a combination of GA and acupuncture. Exclusion criteria were no acupuncture during surgery, no GA during surgery, only postoperative data available, animal studies, and low grade of evidence. Results: The use of acupuncture significantly reduced the amount of volatile anesthetics during surgery (P

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The Trigemino-cardiac Reflex: Is Treatment With Atropine Still Justified?

No abstract available

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Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury

Background: Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. Materials and Methods: We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score 20 mm Hg), cerebral hypotension (cerebral perfusion pressure40 mm Hg), hypocarbia (end-tidal CO2200 mg/dL), hypoglycemia (glucose38°C). Results: A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (P

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Large-volume Epidural Blood Patch: An Alternative Technique

No abstract available

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Cerebral Gaseous Microemboli are Detectable During Continuous Venovenous Hemodialysis in Critically Ill Patients: An Observational Pilot Study

Background: Continuous venovenous hemodialysis (CVVHD) may generate microemboli that cross the pulmonary circulation and reach the brain. The aim of the present study was to quantify (load per time interval) and qualify (gaseous vs. solid) cerebral microemboli (CME), detected as high-intensity transient signals, using transcranial Doppler ultrasound. Materials and Methods: Twenty intensive care unit (ICU group) patients requiring CVVHD were examined. CME were recorded in both middle cerebral arteries for 30 minutes during CVVHD and a CVVHD-free interval. Twenty additional patients, hospitalized for orthopedic surgery, served as a non-ICU control group. Statistical analyses were performed using the Mann-Whitney U test or the Wilcoxon matched-pairs signed-rank test, followed by Bonferroni corrections for multiple comparisons. Results: In the non-ICU group, 48 (14.5-169.5) (median [range]) gaseous CME were detected. In the ICU group, the 67.5 (14.5-588.5) gaseous CME detected during the CVVHD-free interval increased 5-fold to 344.5 (59-1019) during CVVHD (P

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Bowel Preparation in Awake Craniotomy: An Overlooked Entity

No abstract available

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Effects of Prone Position and Positive End-Expiratory Pressure on Noninvasive Estimators of ICP: A Pilot Study

Background: Prone positioning and positive end-expiratory pressure can improve pulmonary gas exchange and respiratory mechanics. However, they may be associated with the development of intracranial hypertension. Intracranial pressure (ICP) can be noninvasively estimated from the sonographic measurement of the optic nerve sheath diameter (ONSD) and from the transcranial Doppler analysis of the pulsatility (ICPPI) and the diastolic component (ICPFVd) of the velocity waveform. Methods: The effect of the prone positioning and positive end-expiratory pressure on ONSD, ICPFVd, and ICPPI was assessed in a prospective study of 30 patients undergoing spine surgery. One-way repeated measures analysis of variance, fixed-effect multivariate regression models, and receiver operating characteristic analyses were used to analyze numerical data. Results: The mean values of ONSD, ICPFVd, and ICPPI significantly increased after change from supine to prone position. Receiver operating characteristic analyses demonstrated that, among the noninvasive methods, the mean ONSD measure had the greatest area under the curve signifying it is the most effective in distinguishing a hypothetical change in ICP between supine and prone positioning (0.86±0.034 [0.79 to 0.92]). A cutoff of 0.43 cm was found to be a best separator of ONSD value between supine and prone with a specificity of 75.0 and a sensitivity of 86.7. Conclusions: Noninvasive ICP estimation may be useful in patients at risk of developing intracranial hypertension who require prone positioning.

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Urinary Retention Manifesting as Excessive Venous Ooze During Cranio-Vertebral Junction Surgery

No abstract available

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Noninvasive Hemodynamic Measurements During Neurosurgical Procedures in Sitting Position

Background: Neurosurgical procedures in sitting position need advanced cardiovascular monitoring. Transesophageal echocardiography (TEE) to measure cardiac output (CO)/cardiac index (CI) and stroke volume (SV), and invasive arterial blood pressure measurements for systolic (ABPsys), diastolic (ABPdiast) and mean arterial pressure (MAP) are established monitoring technologies for these kind of procedures. A noninvasive device for continuous monitoring of blood pressure and CO based on a modified Penaz technique (volume-clamp method) was introduced recently. In the present study the noninvasive blood pressure measurements were compared with invasive arterial blood pressure monitoring, and the noninvasive CO monitoring to TEE measurements. Methods: Measurements of blood pressure and CO were performed in 35 patients before/after giving a fluid bolus and a change from supine to sitting position, start of surgery, and repositioning from sitting to supine at the end of surgery. Data pairs from the noninvasive device (Nexfin HD) versus arterial line measurements (ABPsys, ABPdiast, MAP) and versus TEE (CO, CI, SV) were compared using Bland-Altman analysis and percentage error. Results: All parameters compared (CO, CI, SV, ABPsys, ABPdiast, MAP) showed a large bias and wide limits of agreement. Percentage error was above 30% for all parameters except ABPsys. Conclusion: The noninvasive device based on a modified Penaz technique cannot replace arterial blood pressure monitoring or TEE in anesthetized patients undergoing neurosurgery in sitting position.

http://ift.tt/2sMsosZ

Pediatric Neurosurgery. Tricks of the Trade

No abstract available

http://ift.tt/2scMFel

Intraoperative and Postoperative Administration of Dexmedetomidine Reduces Anesthetic and Postoperative Analgesic Requirements in Patients Undergoing Cervical Spine Surgeries

Background: Early recovery from anesthesia and avoidance of analgesics with respiratory depressant properties are vital for maintenance of extubated airway in cervical spine surgeries. The current study investigated the role of dexmedetomidine as an anesthetic sparing agent and as a sole postoperative analgesic in these cases. Materials and Methods: Sixty adult patients undergoing cervical spine surgeries were randomized into 2 groups. Group D received intravenous dexmedetomidine infusion 0.5 μg/kg/h throughout the surgery after a loading dose of 1 μg/kg over 10 minutes. Postoperatively, dexmedetomidine infusion was continued at 0.2 μg/kg/h for 24 hours. Group C received a volume-matched bolus and infusion of 0.9% saline. Intraoperative anesthetic requirement, time to recovery, and discharge were recorded. Patients were observed for rescue analgesic requirements for 24 hours after surgery. Hemodynamic stability, sedation scores, and pain scores were assessed for 48 hours after surgery. Results: There was significant reduction in intraoperative anesthetic requirement in group D (P

http://ift.tt/2sddNtJ

Unusual Presentation of Refractory Autonomic Dysreflexia During General Anesthesia

No abstract available

http://ift.tt/2sMlh41

Latent Class Analysis of Neurodevelopmental Deficit After Exposure to Anesthesia in Early Childhood

Introduction: Although some studies have reported an association between early exposure to anesthesia and surgery and long-term neurodevelopmental deficit, the clinical phenotype of children exposed to anesthesia is still unknown. Methods: Data were obtained from the Western Australian Pregnancy Cohort Study (Raine) with neuropsychological tests at age 10 years measuring language, cognition, motor function, and behavior. Latent class analysis of the tests was used to divide the cohort into mutually exclusive subclasses of neurodevelopmental deficit. Multivariable polytomous logistic regression was used to evaluate the association between exposure to surgery and anesthesia and each latent class, adjusting for demographic and medical covariates. Results: In our cohort of 1444 children, latent class analysis identified 4 subclasses: (1) Normal: few deficits (n=1135, 78.6%); (2) Language and Cognitive deficits: primarily language, cognitive, and motor deficits (n=96, 6.6%); (3) Behavioral deficits: primarily behavioral deficits, (n=151, 10.5%); and (4) Severe deficits: deficits in all neuropsychological domains (n=62, 4.3%). Language and cognitive deficit group children were more likely to have exposure before age 3 (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.17-3.81), whereas a difference in exposure was not found between Behavioral or Severe deficit children (aOR, 1.00; 95% CI, 0.58-1.73, and aOR, 0.85; 95% CI, 0.34-2.15, respectively) and Normal children. Conclusions: Our results suggest that in evaluating children exposed to surgery and anesthesia at an early age, the phenotype of interest may be children with deficits primarily in language and cognition, and not children with broad neurodevelopmental delay or primarily behavioral deficits.

http://ift.tt/2sMle8l

Acute Reduction in the End-Tidal Carbon Dioxide Level During Neurosurgery: Another Cause for Capnography Artifact

No abstract available

http://ift.tt/2sMnWdV

Use of Dexmedetomidine Along With Local Infiltration Versus General Anesthesia for Burr Hole and Evacuation of Chronic Subdural Hematoma (CSDH)

Background: In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general anesthesia (GA) and local anesthesia with or without sedation are used for the surgical treatment of CSDH. Sedation with dexmedetomidine has been safely used for various diagnostic and therapeutic procedures. However, its effectiveness against GA has not been evaluated for surgical treatment of CSDH. We tried to compare dexmedetomidine sedation technique with the GA technique for surgical treatment of CSDH. Materials and Methods: In this prospective-randomized study, 76 patients undergoing surgery for CSDH were divided into 2 groups using computer-generated randomized tables; Dex group ([n=38]; received IV bolus of dexmedetomidine 1 mcg/kg over 10 min followed by maintenance infusion 0.5 mcg/kg/h) and GA group ([n=38; of which 4 patients were dropped out]; received endotracheal intubation with balanced anesthesia). Results: Both anesthesia techniques (Dex group; n=35/38 [92.1%] and GA group; n=34/34 [100%]) were successfully used for surgical treatment of CSDH. Significantly less time for anesthesia onset (14.2±4.2 vs. 20.5±3.4 min, P=0.001), total duration of surgery (77.1±23.9 vs. 102.7± 24.8 min, P=0.001), and recovery from anesthesia (7.4±5.9 vs. 13.2±6.5 min, P=0.004) was observed in the Dex group compared with GA group. Perioperative hemodynamic fluctuations were more common in the GA group as against the Dex group. Postoperative complications (n=2 vs. 9, P=0.021) and length of hospital stay (1.05±0.23 vs. 1.79±2.1 d, P=0.007) were significantly less in the Dex group as against the GA group. Conclusions: Dexmedetomidine sedation with local anesthesia is a safe and effective technique for burr hole and evacuation of CSDH. It is associated with significantly shorter operative time, lesser hemodynamic fluctuations, postoperative complications, and length of hospital stay, thus it is a better alternative to GA.

http://ift.tt/2sMlbtb

Obscure Retropharyngeal Mucocutaneous Masses Associated With Acoustic Neurofibromatosis: A Source of Difficult Airway Management

No abstract available

http://ift.tt/2sM8L4d

The Prophylactic Use of Remifentanil for Delayed Extubation After Elective Intracranial Operations: a Prospective, Randomized, Double-Blinded Trial

Background: Endotracheal extubation is a painful and stressful procedure. The authors hypothesized that the prophylactic use of remifentanil would attenuate the pain intensity and stress responses resulting from extubation in neurosurgical patients. Materials and Methods: In this prospective, randomized, double-blinded, controlled trial, 160 patients with planned delay extubation after elective intracranial operation were randomized 1:1 to receive either remifentanil or normal saline (control) before their extubation. The dose regime of remifentanil was a bolus of 0.5 μg/kg over 1 minute, followed by a continuous infusion of 0.05 μg/kg/min for 20 minutes. The primary outcome was the incidence of severe pain during the periextubation period. Secondary outcomes included changes in the pain intensity and vital signs, failing to pass an extubation evaluation after the study drug infusion, severe adverse events, postextubation complications, and clinical outcomes. Results: Two patients in the remifentanil group did not pass the extubation evaluation. The incidence of severe pain during the periextubation period was significantly lower in the remifentanil group compared with the control group (25.0% vs. 41.3%, P=0.029). Compared with the control group, the visual analog scale in the remifentanil group was significantly lower after the bolus of remifentanil (12±18 vs. 25±27, P=0.001) and immediately after extubation (19±25 vs. 34±30, P=0.001). There were no significant differences in the vital signs immediately after extubation between the 2 groups (P>0.05). Conclusions: The prophylactic use of remifentanil decreases the incidence of severe pain. Our preliminary findings merit a larger trial to clarify the effect of the prophylactic use of remifentanil on clinical outcomes and adverse events.

http://ift.tt/2sMjGLv

Ixekizumab Eases Psoriatic Arthritis When TNF Inhibitor Fails

The selective interleukin-17A inhibitor ixekizumab improved signs and symptoms of active psoriatic arthritis (PsA) in patients who had failed prior biologic therapy in the phase 3 SPIRIT-P2 trial.
Reuters Health Information

http://ift.tt/2racI5H

VEGF protein expression is associated with a poor prognosis in cutaneous extranodal NK/T-cell lymphoma patients

Abstract

Vascular endothelial growth factor (VEGF) can stimulate angiogenesis and lymphangiogenesis, which are crucial processes in the growth and metastasis of tumour cells.^1,2 The immunohistochemical status of VEGF protein expression in tumour tissue of extranodal NK/T-cell lymphoma (ENKTL) has not yet been evaluated. Herein, we investigated VEGF protein expression, as well as its prognostic value in cutaneous ENKTL patients.

http://ift.tt/2rJPIcw

Coexistence of EphB1 and EphrinB2 in Port Wine Stain Endothelial Progenitor Cells Contributes to Clinicopathological Vasculature Dilatation

Abstract

Port wine stain (PWS) is a vascular malformation characterized by a progressive dilatation of post-capillary venules, but the molecular pathogenesis remains obscure. We hypothesized that PWS endothelial cells (ECs) present a unique molecular phenotype that lead to pathoanatomic PWS vasculatures. We herein show multiple clinicopathologic features of PWS blood vessels during the development and progression of the disease. 1) There were no normal arterioles and venules phenotypically and morphologically observed in PWS skin; both arterioles and venules showed differentiation impairments, resulting in a reduction of arteriole-like vasculatures and defects in capillary loop formation in PWS lesions. 2) PWS ECs showed stemness properties with expression of endothelial progenitor cell markers CD133 and CD166. They also expressed dual venous/arterial identities, EphB1 and ephrinB2. 3) Co-expression of EphB1 and ephrinB2 in normal human dermal microvascular ECs led to formation of PWS-like vasculatures in vitro, e.g. larger diameter and thick-wall capillaries. We concluded that PWS ECs are differentiation-impaired late stage endothelial progenitor cells with a specific phenotype of CD133⁺/CD166⁺/ EphB1⁺/ephrinB2⁺ which form immature venule-like pathoanatomic vasculatures. The disruption of normal EC-EC interactions by co-existence of EphB1 and ephrinB2 contributes to progressive dilatation of PWS vasculatures.

http://ift.tt/2reoMxT

A new fluorescent-avidin-based method for quantifying basophil activation in whole blood

Publication date: Available online 9 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Kaori Mukai, R. Sharon Chinthrajah, Kari C. Nadeau, Mindy Tsai, Nicolas Gaudenzio, Stephen J. Galli

Teaser

We report herein a simple new fluorescent-avidin-based method to detect activated basophils in the whole blood of normal or allergic subjects, and compare this method to a basophil activation test based on detection of CD63.

http://ift.tt/2sc8I4K

Asthma Control Status in Pregnancy, BMI, and Maternal Vitamin D Levels

Publication date: Available online 9 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hooman Mirzakhani, George O'Connor, Leonard B. Bacharier, Robert S. Zeiger, Michael X. Schatz, Scott T. Weiss, Augusto A. Litonjua

Teaser

Higher maternal 25OHD levels at early pregnancy could reduce the associated risk of uncontrolled asthma status during pregnancy. Obesity might attenuate this effect and is a predictor of uncontrolled status during pregnancy.

http://ift.tt/2sLE6nX

Cancer in primary immunodeficiency diseases: Cancer incidence in the United States Immune Deficiency Network Registry

Publication date: Available online 9 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Paul C. Mayor, Kevin H. Eng, Kelly L. Singel, Scott I. Abrams, Kunle Odunsi, Kirsten B. Moysich, Ramsay Fuleihan, Elizabeth Garabedian, Patricia Lugar, Hans D. Ochs, Francisco A. Bonilla, Rebecca H. Buckley, Kathleen E. Sullivan, Zuhair K. Ballas, Charlotte Cunningham-Rundles, Brahm H. Segal
BackgroundWe evaluated the overall and site-specific incidence of cancer in subjects with primary immunodeficiency diseases (PIDD) enrolled in the United States Immune Deficiency Network (USIDNET) registry compared with age-adjusted cancer incidence in the Surveillance, Epidemiology and End Results Program (SEER) database. We hypothesized that subjects with PIDD would have an increased incidence of cancer due to impaired immune function.MethodsOverall and site-specific cancer incidence rates were evaluated in subjects with PIDD (n = 3,658) enrolled in the USIDNET registry from 2003-2015, and compared with age-adjusted incidence rates in the SEER database.ResultsWe observed a 1.42-fold excess relative risk of cancer in subjects with PIDD compared to the age-adjusted SEER population (p<0.001). Men with PIDD had a 1.91-fold excess relative risk of cancer compared to the age-adjusted male population (p<0.001), while women with PIDD had similar overall cancer rates compared to the age-adjusted female population. Of the four most common malignancies in men and women in SEER (lung, colon, breast, and prostate cancers), we found no significant increase in these diagnoses in subjects with PIDD. Significant increases in lymphoma in both men (10-fold increase, p<0.001) and women (8.34-fold increase, p<0.001) with PIDD were observed.ConclusionsExcess incidence of cancer occurred in subjects with PIDD. An excess of lymphoma in specific PIDD populations principally drove this increased incidence, while no increased risk of the most common solid tumor malignancies was observed. These data point to a restricted role of the immune system in protecting from specific cancers.

Teaser

This study demonstrates that patients with primary immunodeficiency diseases have an increased risk of certain cancers, but have similar risks as the age-matched general population of developing the most common solid tumor malignancies.

http://ift.tt/2scjGHF

Age-specific profiling of cutaneous allergy at high temporal resolution suggests age-related alterations in regulatory immune function

Publication date: Available online 9 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Magnus David Lynch, John Paul McFadden, Jonathan Michael White, Piu Banerjee, Ian Richard White
We report the age-specific prevalence of cutaneous allergy in 45110 patients over a 30 year period. Our analysis reveals complex allergen-specific sensitization profiles which may reflect alterations in T-cell mediated immunity and regulatory immune function.

http://ift.tt/2sLZs4D

Regulatory effects of Interleukin (IL)-15 on allergen-induced airway obstruction

Publication date: Available online 9 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sathisha Upparahalli Venkateshaiah, Xiang Zhu, Priya Rajavelu, Rituraj Niranjan, Murli Manohar, Alok K. Verma, Joseph A. Lasky, Anil Mishra
BackgroundAirway obstruction is a physiologic feature of asthma and IL-15 may have an important role in the pathogenesis of asthma.ObjectiveWe tested the hypothesis that regulation of IL-15 is critical for the preservation of allergen-induced airway hyperresponsiveness (AHR), airway resistance and compliance in response to methacholine.MethodsAirway inflammation, AHR, resistance and compliance were assessed in IL-15- gene deficient mice and IL-15 overexpressing mice in an allergen-induced murine model of asthma. We assessed eosinophils by anti-MBP immunostaining, goblet cells hyperplasia by PAS staining, and cytokines and chemokine levels by performing qPCR and ELISA analyses.ResultsHerein, we made a novel observation that IL-15 deficiency promotes baseline airway resistance in naïve mice. Moreover, rIL-15 delivery to the lung downregulates expression of proinflammatory cytokines, and improves allergen-induced AHR, resistance and compliance. These observations were further validated in DOX-inducible CC-10-IL-15 transgenic mice. DOX exposed Aspergillus extract challenged CC-10-IL-15 bitransgenic mice exhibited significantly reduced levels of proinflammatory cytokines (IL-4, IL-5, IL-13) and decreased goblet cell hyperplasia. Airway obstruction including AHR and resistance was diminished in allergen challenged DOX exposed mice compared to non-DOX exposed CC-10-IL-15 bitransgenic mice. Mechanistically, we observed that IL-15-mediated protection of airway obstruction is associated with induced IFN-γ and IL-10-producing regulatory CD4⁺CD25⁺Foxp3⁺ T cells. Additionally, we found that a human IL-15 agonist (ALT-803) improved airway resistance and compliance in an experimental asthma model.ConclusionWe report our novel finding that IL-15 has a potent inhibitory effect on the airway obstruction that occurs in response to environmental allergens.

Teaser

IL-15 deficiency promotes airway obstruction and IL-15 overexpression protects mice from allergen-Induced airway obstruction including AHR , resistance and compliance in an experimental asthma model.

http://ift.tt/2scnqc4

Identification of CD146 as a novel molecular actor involved in systemic sclerosis

Publication date: Available online 9 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Elise Kaspi, Xavier Heim, Brigitte Granel, Benjamin Guillet, Jimmy Stalin, Marie Nollet, Alexandrine Bertaud-Foucault, Andrée Robaglia-Schlupp, Patrice Roll, Pierre Cau, Aurélie Leroyer, Richard Bachelier, Audrey Benyamine, Françoise Dignat-George, Marcel Blot-Chabaud, Nathalie Bardin

http://ift.tt/2sLOoV4

Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines – 2016 Revision

Publication date: Available online 8 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jan L. Brożek, Jean Bousquet, Ioana Agache, Arnav Agarwal, Claus Bachert, Sinthia Bosnic-Anticevich, Romina Brignardello-Petersen, G. Walter Canonica, Thomas Casale, Niels H. Chavannes, Jaime Correia de Sousa, Alvaro A. Cruz, Carlos A. Cuello-Garcia, Pascal Demoly, Mark Dykewicz, Itziar Etxeandia-Ikobaltzeta, Ivan D. Florez, Wytske Fokkens, Joao Fonseca, Peter W. Hellings, Ludger Klimek, Sergio Kowalski, Piotr Kuna, Kaja-Triin Laisaar, Désirée E. Larenas-Linnemann, Karin C. Lødrup Carlsen, Peter J. Manning, Eli Meltzer, Joaquim Mullol, Antonella Muraro, Robyn O'Hehir, Ken Ohta, Petr Panzner, Nikolaos Papadopoulos, Hae-Sim Park, Gianni Passalacqua, Ruby Pawankar, David Price, John J. Riva, Yetiani Roldán, Dermot Ryan, Behnam Sadeghirad, Boleslaw Samolinski, Peter Schmid-Grendelmeier, Aziz Sheikh, Alkis Togias, Antonio Valero, Arunas Valiulis, Erkka Valovirta, Matthew Ventresca, Dana Wallace, Susan Waserman, Magnus Wickman, Wojtek Wiercioch, Juan José Yepes-Nuñez, Luo Zhang, Yuan Zhang, Mihaela Zidarn, Torsten Zuberbier, Holger J. Schünemann
BackgroundAllergic rhinitis affects 10 to 40% of the population. It reduces quality of life, school and work performance, and is a frequent reason for office visits in general practice. Medical costs are large but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma – ARIA guidelines in 2010 prompting its update.ObjectiveTo provide a targeted update of the ARIA guidelines.MethodsThe ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patient values and preferences, and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations.ResultsThe 2016 revision of the ARIA guidelines provides updated and new recommendations about the pharmacological treatment of allergic rhinitis. It specifically addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or their combination. The ARIA guideline panel provides specific recommendations for the choice of treatment, the rationale for the choice, and discusses specific considerations that clinicians and patients may want to review in order to choose the management most appropriate for an individual patient.ConclusionsAppropriate treatment of allergic rhinitis may improve patients' quality of life, school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.

http://ift.tt/2schPTb

MucoJet: A Novel Oral Microjet Vaccination System

Abstract

In a recent publication in Science Translational Medicine 9:1-9, Aran et al (2017) provide a series of elegant experiments that present an innovative noninvasive intraoral method for vaccination that uses a device termed MucoJet (Aran et al, 2017). Their findings delineate an easy to use system involving jet velocity to penetrate buccal mucosa and deliver a vaccine to underlying immune cells. This technology provides a launching pad for several potential innovations for healthcare.

http://ift.tt/2scd1xb

Musculoskeletal Changes as a Sequel to Advancement Genioplasty: A Long-Term Cephalometric Prospective Study

Abstract

Aims

The aim of this study was to evaluate cephalometrically the stability of hard tissues and soft tissue changes of advancement genioplasty 2 years after surgery.

Methods

A prospective study was conducted which comprised of 25 patients, who underwent advancement genioplasty alone with no other orthognathic surgical procedures. Immediate pre-operative, 6 months postoperative, and 2 years postoperative lateral cephalograms were compiled and assessed.

Results

The mean surgical advancement planned was around 8 mm. Six months post-surgery, the relapse rate was 15% of the surgical advancement which was considerably reduced in the following 18 months to 7%. The ratio of soft tissue to bony advancement at pogonion was 0.9:1. There are significant alterations in the soft tissue profile in terms of decrease in the soft tissue thickness, facial convexity angle, deepened mentolabial sulcus and minimal increase in the lower lip height.

Conclusion

Advancement genioplasty was considered as a relatively stable procedure, if adequate muscular pedicle and internal rigid fixation were maintained. The present study was of 2 years, and we can expect further changes in the hard and soft tissues, which are clinically irrelevant.

http://ift.tt/2rewyI9

Pattern of care and impact of prognostic factors in the outcome of ameloblastic carcinoma: a systematic review and individual patient data analysis of 199 cases

Abstract

Ameloblastic carcinoma is a rare locally aggressive odontogenic neoplasm. These tumors are most commonly found to arise from mandible. Because of rarity, there is limited information about the clinical behaviour of such patients. We intended to perform this review of published literature to assess the demographic profile, pattern of care and assess survival outcomes. Two authors independently searched PubMed, Google search, and Cochrane library for eligible studies from 1950 until July 1 2016 published in English language. Data of 199 patients were retrieved from 94 publications for statistical analysis. Median age of the entire cohort was 49 years (range 7–91 years). The analysis revealed that a clear twofold higher incidence in male with male-to-female ratio was 2.4:1 (140:57). Mandible was found to be the commonest tumor location in 66.7% (n = 132) cases followed by maxilla (31.8%) (n = 64). The present analysis revealed that median PFS of 57 months (95% CI 39–120 months) with 5- and 10-year PFS was found to be 47.88 and 29.48%, respectively. Median OS for the entire cohort which was 122 months (95% CI 96–153 months) with 2- and 5-year OS for the entire cohort was 87.16 and 69.08%, respectively. In univariate analysis, patients with an R0 resection were found to have a favourable survival. In addition, patients with localized disease and younger age were found to have a better survival. Adjuvant radiation did not confer any survival advantage. The present analysis revealed excellent outcome for patients treated with an R0 resection. Older patients with high-risk factor may benefit from adjuvant radiation. Role of chemotherapy needs to be evaluated.

http://ift.tt/2smX8TZ

Increased risk of asthma in overweight children born large for gestational age

Abstract

Background

Being born large for gestational age (LGA) is a marker of increased growth velocity in fetal life and a risk factor for childhood overweight. Both being born LGA and childhood overweight may influence the development of asthma, although the role of overweight in the association between LGA and childhood asthma is unclear. Importantly, recent studies have suggested that the association between overweight and asthma may be related to non-allergic pathways. If this also applies to the association between LGA and asthma, the association between being born LGA and asthma may be different for atopic and non-atopic children.

Objective

We investigated the association of being LGA with the prevalence of asthma at age 8 in atopic and non-atopic children and the role of overweight in this association.

Methods

Complete data on asthma, anthropometry and atopy at age 8 years, and potential confounders were available for 1,608 participants of the PIAMA birth cohort. Odds ratios for the association between LGA and asthma in atopic and non-atopic children were estimated by logistic regression analysis adjusting for potential confounders. Overweight was assessed as a potential modifier of the association between LGA and asthma.

Results

Being born LGA was not significantly associated with asthma at age 8 in atopic and non-atopic children. However, overweight at age 8 years modified the association between asthma at age 8 and LGA. In non-atopic children, children who were born LGA and were overweight at age 8 years had a significantly increased odds of asthma compared to non-LGA, non-overweight children (adj OR 7.04; 95% CI 2.2-24).

Conclusions

We observed that non-atopic children born LGA, who were overweight by 8 years have an increased risk of asthma. If confirmed, these findings suggest that non-atopic children born LGA may be identified early in life as a high-risk group for asthma.

http://ift.tt/2s5wPkH

Intrauterine death following intraamniotic triiodothyronine and thyroxine therapy for fetal goitrous hypothyroidism associated with polyhydramnios and caused by a thyroglobulin mutation

Summary

In the absence of maternal thyroid disease or iodine deficiency, fetal goitre is rare and usually attributable to dyshormonogenesis, for which genetic ascertainment is not always undertaken in the UK. Mechanical complications include tracheal and oesophageal compression with resultant polyhydramnios, malpresentation at delivery and neonatal respiratory distress. We report an Indian kindred in which the proband (first-born son) had congenital hypothyroidism (CH) without obvious neonatal goitre. His mother's second pregnancy was complicated by fetal hypothyroid goitre and polyhydramnios, prompting amniotic fluid drainage and intraamniotic therapy (with liothyronine, T3 and levothyroxine, T4). Sadly, intrauterine death occurred at 31 weeks. Genetic studies in the proband demonstrated compound heterozygous novel (c.5178delT, p.A1727Hfs*26) and previously described (c.7123G > A, p.G2375R) thyroglobulin (TG) mutations which are the likely cause of fetal goitre in the deceased sibling. TG mutations rarely cause fetal goitre, and management remains controversial due to the potential complications of intrauterine therapy however an amelioration in goitre size may be achieved with intraamniotic T4, and intraamniotic T3/T4 combination has achieved a favourable outcome in one case. A conservative approach, with surveillance, elective delivery and commencement of levothyroxine neonatally may also be justified, although intubation may be required post delivery for respiratory obstruction. Our observations highlight the lethality which may be associated with fetal goitre. Additionally, although this complication may recur in successive pregnancies, our case highlights the possibility of discordance for fetal goitre in siblings harbouring the same dyshormonogenesis-associated genetic mutations. Genetic ascertainment may facilitate prenatal diagnosis and assist management in familial cases.

Learning points:

CH due to biallelic, loss-of-function TG mutations is well-described and readily treatable in childhood however mechanical complications from associated fetal goitre may include polyhydramnios, neonatal respiratory compromise and neck hyperextension with dystocia complicating delivery.

CH due to TG mutations may manifest with variable phenotypes, even within the same kindred.

Treatment options for hypothyroid dyshormogenic fetal goitre in a euthyroid mother include intraamniotic thyroid hormone replacement in cases with polyhydramnios or significant tracheal obstruction. Alternatively, cases may be managed conservatively with radiological surveillance, elective delivery and neonatal levothyroxine treatment, although intubation and ventilation may be required to support neonatal respiratory compromise.

Genetic ascertainment in such kindreds may enable prenatal diagnosis and anticipatory planning for antenatal management of further affected offspring.

http://ift.tt/2s5gHzZ

Beyond epithelial-to-mesenchymal transition: common suppression of differentiation programs underlies epithelial barrier dysfunction in mild, moderate and severe asthma

Abstract

Background

Epithelial barrier dysfunction is a central feature in the pathogenesis of allergic disease. Epithelial-to-mesenchymal transition (EMT) has been proposed as one mechanism afflicting barrier in asthma. However, genes and pathways involved in aberrant epithelial-mesenchymal signaling, and their relationship to asthma severity, are poorly understood.

Methods

We used unbiased gene network analysis to evaluate functional convergence in epithelial gene expression signatures across multiple public access transcriptomics datasets of human asthma, followed by text mining to evaluate functional marker relevance of discovered genes. We objectively confirmed these findings in epithelial brushings and primary asthmatic epithelial cells cultured in different biological contexts.

Results

We found a striking suppression of epithelial differentiation in asthma, overrepresented by insufficiency in insulin and Notch signaling, but with the absence of conventional EMT markers. We identified EFNB2, FGFR1, FGFR2, INSR, IRS2, NOTCH2, TLE1, and NTRK2 as novel markers central to dysregulation of epithelial-mesenchymal signaling, but surprisingly overlooked in asthma research. We found that this "core" signature of asthma is shared by mild, moderate, and severe forms of disease, progressing with severity. Loss of epithelial differentiation induced by insulin deprivation in normal human bronchial epithelial cells cultured in organotypic conditions closely approximated gene expression in asthmatic epithelial brushings.

Conclusions

The comparative analysis of publically available transcriptomes demonstrated that epithelial barrier dysfunction in asthma is characterized by persistent underlying de-differentiation program with complex etiology. The lasting alteration of the asthmatic epithelial cell transcriptome implicates regulation involving metabolism and epigenetics, beyond EMT driven by injury and repair in chronic inflammation.

http://ift.tt/2sLlmoB

Non-lesional atopic dermatitis skin shares similar T-cell clones with lesional tissues

Abstract

Background

Atopic dermatitis (AD) is characterized by robust immune activation. Various T-cell subsets, including Th2/Th22 cells, are increased in lesional and non-lesional skin. However, there is conflicting literature on the diversity of the T-cell receptor (TCR) repertoire in lesional AD, and its relation to non-lesional skin remains unclear.

Methods

We performed high-throughput deep sequencing of the β-TCR repertoire in 29 lesional and 19 non-lesional AD biopsies, compared to 6 healthy control and 6 cutaneous T-cell lymphoma (CTCL) samples from previously published cohorts.

Results

While greater T-cell infiltrates were observed in lesional vs. non-lesional AD, TCR repertoire diversity was similar in lesional and non-lesional tissues, and absolute numbers of unique T-cell clones correlated with respective T-cell counts. Most (87%) top expanded lesional T-cell clones were shared with non-lesional tissues, and they were largely maintained after 16 weeks of successful treatment with topical triamcinolone. Nevertheless, both lesional and non-lesional AD showed a highly polyclonal TCR pattern, without evidence of oligoclonal expansion, or a preferred usage of certain V-β genes in AD skin. Size of the overall T-cell infiltrate, but not the level of clonality, correlated with mRNA levels of key inflammatory mediators (e.g. IL-13, CCL17, IL23p19, CXCL10).

Conclusion

While AD harbors a highly polyclonal T-cell receptor repertoire, and despite the lack of information on TCR antigen specificity, the sharing of top abundant clones between lesional and non-lesional skin, and their persistence after months of therapy, points to the continuous presence of potentially pathogenic skin resident memory T-cells well beyond clinically inflamed lesions.

http://ift.tt/2sc252n

Mechanisms of exercise-induced bronchoconstriction in athletes: current perspectives and future challenges

Abstract

The evidence of exercise-induced bronchoconstriction (EIB) without asthma (EIBw_A) occurring in athletes led to speculate about different endotypes inducing respiratory symptoms within athletes. Classical postulated mechanisms for bronchial obstruction in this population include the osmotic and the thermal hypotheses. More recently, the presence of epithelial injury and inflammation in the airways of athletes was demonstrated. In addition, neuronal activation has been suggested as a potential modulator of bronchoconstriction. Investigation of these emerging mechanisms are of major importance since EIB is a significant problem for both recreational and competitive athletes and is the most common chronic condition among Olympic athletes, with obvious implications for their competing performance, health and quality of life. Hereby we summarize the latest achievements in this area and identify the current gaps of knowledge so that future research heads towards better defining the etiologic factors and mechanisms involved in development of EIB in elite athletes as well as essential aspects to ultimately propose preventive and therapeutic measures.

http://ift.tt/2sLsKjI

A possible role of stem cells in nasal polyposis

Abstract

Since its discovery, the understanding of stem/progenitor cells raised dramatically in the last decade. Their regenerative potential is important to develop new therapeutic applications, but the identification advanced much faster than our understanding of stem/progenitor cells. In nasal polyposis, little is known about stem cells/progenitor cells and their ability. However, the further characterization of stem cells/progenitor cells may provide new treatment options for combating nasal polyposis. This review highlights the knowledge of the current literature about stem cells/progenitor cells in nasal polyposis and how this may be exploited in the development of novel treatment strategies.

http://ift.tt/2sc53nL

Why are we still unable to accurately determine the malignant potential or the behavior of oral mucosal lesions?

Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Gargi S. Sarode, Sachin C. Sarode, Shankargouda Patil

http://ift.tt/2smOapN

Craniofacial and extracraniofacial anomalies in craniofacial macrosomia: A multicenter study of 755 patients

Publication date: Available online 8 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Cornelia J.J.M. Caron, Britt I. Pluijmers, Eppo B. Wolvius, C.W.N. Looman, Neil Bulstrode, Robert D. Evans, Peter Ayliffe, John B. Mulliken, David Dunaway, Bonnie Padwa, Maarten J. Koudstaal
PurposeCraniofacial 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.Material and MethodsA retrospective study was conducted in patients diagnosed with CFM with available clinical and/or radiographic images. All charts were reviewed for information on demographic, radiographic and diagnostic criteria. The presence of cleft lip/palate and extracraniofacial anomalies were noted. Pearson correlation tests and principal component analysis was performed on the phenotypic variables.ResultsA total of 755 patients were included. The male-to-female ratio and right-to-left ratio were both 1.2:1. A correlation was found among Pruzansky–Kaban, orbit and soft tissue. Similar correlations were found between ear and nerve. There was no strong correlation between phenotype and extracraniofacial anomalies. Nevertheless, extracraniofacial anomalies were more frequently seen than in the 'normal' population. Patients with bilateral involvement had a more severe phenotype and a higher incidence of extracraniofacial and cleft lip/palate.ConclusionOutcomes were similar to those of other smaller cohorts. Structures derived from the first pharyngeal arch and the second pharyngeal arch were correlated with degree of severity. Extracraniofacial anomalies were positively correlated with CFM. The findings show that bilaterally affected patients are more severely affected and should be approached more comprehensively.

http://ift.tt/2t2Msa7

Intrauterine death following intraamniotic triiodothyronine and thyroxine therapy for fetal goitrous hypothyroidism associated with polyhydramnios and caused by a thyroglobulin mutation

Summary

Learning points:

CH due to TG mutations may manifest with variable phenotypes, even within the same kindred.

Genetic ascertainment in such kindreds may enable prenatal diagnosis and anticipatory planning for antenatal management of further affected offspring.

http://ift.tt/2s5gHzZ

Delivered adipose-derived stromal cells improve host-derived adipose tissue formation in composite constructs in vivo

Objectives/Hypothesis

Adipose tissue engineering aims to provide functional tissue surrogates for the restoration of soft tissue defects and contour deformities in the face. Many studies involve the delivery of cells; however, the impact and the exact role of the implanted cells is not yet fully elucidated.

Study Design

Animal research.

Methods

In this study, we used a mouse model for the development of volume-stable adipose tissue using polyurethane scaffolds combined with a long-term stable fibrin gel and adipose-derived stromal cells to investigate the influence of cell delivery on tissue development.

Results

After 12 weeks in vivo, the emerging tissue in these constructs was shown to be exclusively of host origin by human-specific vimentin staining. Comparison of unseeded versus seeded scaffolds revealed a significant effect of the delivered cells on adipose tissue development as shown by histological staining and histomorphometric quantification of adipocytes, whereas blood vessel formation was not affected by delivery of adipose-derived stromal cells at this time point.

Conclusions

This is evidence for an indirect action of the implanted cells, providing a proadipogenic microenvironment within constructs, which was further boosted by adipogenic precultivation of the seeded constructs. Especially in peripheral areas of the constructs, the number of adipocytes was significantly elevated in seeded scaffolds compared to nonseeded controls, suggesting that the implanted cells likely triggered the invasion and differentiation of host cells. This is supported by the fact that the provision of a fat rich environment (by coverage of the constructs with a fat flap upon implantation) additionally stimulated adipose tissue formation.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2sbFy5Q

Pediatric cochlear implantation: Variation in income, race, payer, and charges across five states

Objectives/Hypothesis

Our objectives were to investigate pediatric cochlear implantation (PCI) across representative states within the United States and analyze any geographical differences in age, median household income, race, insurance, and total medical charges.

Study Design

Cross-sectional.

Methods

Data from children (aged 0.5–18 years) who received cochlear implantation surgery were collected from the 2011 State Ambulatory Surgery and Services Databases from California (CA), Florida (FL), Maryland (MD), New York (NY), and Kentucky (KY) as a part of the Healthcare Cost and Utilization Project. We performed data analysis using a combination of Kruskal-Wallis and Wilcoxon rank sum tests, as well as nominal logistic regression.

Results

Five hundred twelve cases of PCI were performed during 2011 across the five states. The overall mean and median age of implantation were 5.6 years and 4 years, respectively. There was no statistical difference in age of implantation across states (P = .85). However, there were statistical differences in primary payer (P < .001), median household income quartiles of patients who received an implant (P < .006), race (P < .001), and total median hospital charges for four of the states, with the exception of CA (P < .001).

Conclusions

Age of PCI appears to be similar across the five states in cross-sectional analysis. Geographic variations in charges, payer, race, and median household income occur with statistical significance in PCI. Further analysis of contributing factors at each state level may help elucidate the root cause of these disparities and improve and justify a uniform approach to healthcare delivery and standards of care.

Level of Evidence

4 Laryngoscope, 2017

http://ift.tt/2sLicRA

Making the case for double-blind peer review in otolaryngology

http://ift.tt/2sc0rhm

Digital innovations and emerging technologies for enhanced recovery programmes

Abstract

Enhanced recovery programmes (ERPs) are increasingly used to improve post-surgical recovery. However, compliance to various components of ERPs—a key determinant of success—remains sub-optimal. Emerging technologies have the potential to help patients and caregivers to improve compliance with ERPs.Preoperative physical condition, a major determinant of postoperative outcome, could be optimized with the use of text messages (SMS) or digital applications (Apps) designed to facilitate smoking cessation, modify physical activity, and better manage hypertension and diabetes. Several non-invasive haemodynamic monitoring techniques and decision support tools are now available to individualize perioperative fluid management, a key component of ERPs. Objective nociceptive assessment may help to rationalize the use of pain medications, including opioids. Wearable sensors designed to monitor cardio-respiratory function may help in the early detection of clinical deterioration during the postoperative recovery and to address 'failure to rescue'. Activity trackers may be useful to monitor early mobilization, another major element of ERPs. Finally, electronic checklists have been developed to ensure that none of the above-mentioned ERP elements is omitted during the surgical journey.By optimizing compliance to the multiple components of ERPs, digital innovations, non-invasive techniques and wearable sensors have the potential to magnify the clinical and economic benefits of ERPs. Among the growing number of technical innovations, studies are needed to clarify which tools and solutions have real clinical value and are cost-effective.

http://ift.tt/2r2TR8D

Association of Helicobacter pylori infection with Parkinson's diseases: A meta-analysis

Abstract

Background

The results from observational studies on the relationship between helicobacter pylori (H. pylori) infection and Parkinson's disease remain controversial. A meta-analysis was conducted to evaluate the association between helicobacter pylori infection and Parkinson's disease.

Methods

A comprehensive literature search was performed on relevant studies published from January 1983 to January 2017 in PubMed, Web of Science and EMBASE databases. The fixed or random effects model was used to pool the odds ratio with 95% confidence interval from individual studies. Publication bias was estimated by Egger's test and the funnel plot.

Results

Eight eligible studies involving 33 125 participants were included in this meta-analysis. Compared with the no helicobacter pylori infected person, the pooled odds ratio of Parkinson's disease in helicobacter pylori infected person was 1.59 (95% confidence interval: 1.37-1.85). In subgroup analyzes, the combined odds ratios were 1.96 (1.23-3.12) in Asia, 1.55 (1.32-1.82) in Europe, 1.59 (1.35-1.88) in case-control studies, 1.56 (1.01-2.39) in cross-sectional studies, 1.56 (1.32-1.85) in studies with confounders adjusted, and 1.71 (1.21-2.43) in studies with no confounder adjusted, respectively.

Conclusions

This meta-analysis indicated that H. pylori infection might be associated with the risk of Parkinson's disease.

http://ift.tt/2rdH8PJ

Mucinous adenocarcinoma in association with hidradenitis suppurativa

http://ift.tt/2rUjtpl

Broccoli Sprout Extract in Preventing Recurrence in Patients With Tobacco-Related Head and Neck Squamous Cell Cancer

Conditions: HNSCC; Head and Neck Cancer; Head and Neck Squamous Cell Carcinoma; Tobacco-Related Carcinoma; Carcinoma in Situ; Dysplasia; Hyperplasia; Premalignant Lesion
Intervention: Drug: Avmacol®
Sponsors: University of Arizona; National Cancer Institute (NCI)
Not yet recruiting - verified June 2017

http://ift.tt/2rdnsvi

Editorial Board

http://ift.tt/2sKTvEL

Performance and Tolerability of the Moisturizers Cetaphil ® and Excipial ® in Atopic Dermatitis: What is the Evidence Based on Randomized Trials?

Abstract

Introduction

Moisturizers play a prominent role in the management of atopic dermatitis by improving the impaired skin barrier function and enhancing skin hydration. Their efficacy was evaluated in a recently published Cochrane Review 'Emollients and moisturizers for eczema'.

Objective

In the present review, we summarize the performance and safety of Cetaphil^® and Excipial^® moisturizing products.

Methods

This review was carried out in compliance with standard Cochrane methodological procedures, which means independent study selection, data extraction, assessment of risk of bias, and analyses by two review authors. The quality of evidence for the predefined outcomes was rated with the GRADE approach. The prespecified outcomes of the review included participant assessments, satisfaction, adverse events, investigator assessments, prevention of flares, change in use of topical active treatment, skin barrier function and quality of life.

Results

Four randomized controlled studies examining these moisturizers were included in the previously published Cochrane Review. For the performance and tolerability of these moisturizers, there was very low to moderate quality evidence for the prespecified outcomes.

Conclusion

The results from these four studies are in line with those of the Cochrane Review that moisturizers themselves have beneficial effects, and that combining moisturizers with active topical treatment produced better results when compared to active topical treatment alone.

http://ift.tt/2s4i7KG

Effect of cochlear implant surgery on vestibular function: meta-analysis study

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 ef...

http://ift.tt/2rd5r0h

Hémangiomatose néonatale bénigne : une observation chez un enfant au Togo

Publication date: Available online 8 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): G. Mahamadou, B. Saka, A. Mouhari-Toure, M. Tchaou, S. Pessinaba, W. Gnassingbé, K. Kombaté, P. Pitché

http://ift.tt/2rIpkzv

Corrigendum

http://ift.tt/2t2d8aJ

Fracture resistance of zirconia-based all-ceramic crowns after bur adjustment

Intra-oral grinding is often required to optimize occlusion of all-ceramic restorations. The effect of burs of different grit size on the fracture resistance of veneered zirconia crowns was investigated in this study. Forty-eight standardized zirconia copings were produced. The ceramic veneer was designed with a positive ellipsoidal defect on the palatal aspect of the crowns. To simulate adjustment of dental restorations by burs, this palatal defect was removed by use of three different diamond-coated burs with grit sizes 46, 107, or 151 μm (fine, medium, or coarse, respectively). Each different grit size of bur was used to grind 16 crowns. All crowns were then polished and surface roughness was measured. Half of the specimens underwent thermomechanical aging (10,000 thermocycles between 6.5°C and 60°C) and 1.2 million cycles of chewing simulation (F = 108 N). A linear regression model was computed to test the effect of aging and grinding grit size at a level of significance of α = 0.05. Fracture loads increased with decreasing grit size. Grit size and aging had a significant effect on the fracture resistance of the crowns. Use of fine and coarse burs for intra-oral adjustments resulted in different fracture resistance of veneered zirconia crowns. Coarse burs should be avoided in the final stage of grinding before polishing.

http://ift.tt/2rd1j0f

An in vitro study of the long non-coding RNA TUG1 in tongue squamous cell carcinoma

Abstract

Background

This study sought to study the expression of the long non-coding RNA (lncRNA)taurine-upregulated gene 1 (TUG1) in tongue squamous cell carcinoma (TSCC) and reveal its possible function.

Methods

qRT-PCR was used to evaluate 27 samples of fresh TSCC tissues and adjacent normal tongue tissues. siRNA technology was employed to down-regulate TUG1 expression in CAL-27 and SCC-9 cell lines.The3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay was utilized to assess cell proliferation ability; apoptosis and cell cycle phases were analysed via flow cytometry.

Results

qRT-PCR findings indicated that the lncRNA TUG1 was up-regulated in TSCC tissues compared with adjacent normal tongue tissues(P<0.05). After TUG1 expression was down-regulated using siRNA technology, cell proliferation was significantly inhibited (P<0.05), and the number of cells in S phase was reduced(P<0.05).

Conclusion

The lncRNA TUG1 may represent a potential oncogene in TSCC.

http://ift.tt/2rcOP8K

Higher concentrations of dithranol appear to induce hair growth even in severe alopecia areata

Abstract

Alopecia areata (AA) is the commonest autoimmune cause of non-scarring alopecia. Topical treatments including corticosteroids and irritants maybe beneficial. Studies report variable hair regrowth with dithranol (anthralin) but all used low concentrations (0.1–1.25%) and inconsistent measurements of AA severity. We report retrospective data (2005–2014) of 102 patients who had failed ultra-potent topical steroids and were referred to a specialist hair clinic for treatment with dithranol up to 3%. The severity of alopecia areata tool was used and participants graded as mild (<25%), moderate (>25 to 75%), and severe (>75%) hair loss. Compared with baseline any and at-least 50% hair regrowth [72%, 68%, 50% and 61.5%, 48.4%, 37.5%, in mild, moderate and severe AA respectively] occurred in all groups (median treatment duration 12 months). Twenty-nine patients (28.4%) were discharged with complete regrowth; with no difference in proportions in severity groups (33.3%, 29%, and 21.9%) but in the period to discharge [7.9, 6.3, and 29.4 months (p-values <.05)] for mild, moderate, and severe AA. Treatment trials of 12 months with dithranol at higher concentrations may be an option in patients who failed potent topical or intra-lesional steroids) regardless of AA severity. Randomized trials (of less staining formulations) of dithranol are warranted.

http://ift.tt/2r8Oj0o

Nuclear protein in testis carcinoma of the mediastinum: a case report

Nuclear protein in testis carcinoma is a rare and very aggressive undifferentiated cancer which characteristically arises in the midline of the head, neck, and mediastinum.

http://ift.tt/2t1wZaa

Recurrence of vocal fold leukoplakia after carbon dioxide laser therapy

Abstract

This work aims to analyze the recurrence of vocal fold leukoplakia after carbon dioxide (CO₂) laser resection. In this retrospective study, all patients undergoing CO₂ laser resection of vocal fold leukoplakia were followed up for at least 2 years. Recurrence was diagnosed as any presence of leukoplakia in the vocal cord subsequent to previous successful complete resection. A total of 326 patients with complete resection of vocal fold leukoplakia and follow-up subsequent surveillance laryngoscopy were studied. The recurrence rate, the recurrence time, and risk factors were evaluated. Of these, 52 (16.0%) patients experienced recurrence with a mean follow-up time of 50.5 ± 15.4 months. The mean time to recurrence was 16.2 ± 14.1 months. Univariate analysis showed that the size of lesion (P < 0.001, Pearson χ ² test; P < 0.001, log-rank test) and the pathological grade (P = 0.025, Pearson χ ² test; P = 0.028, log-rank test) were significantly related to recurrence. The size of lesion was an independent prognostic factor for recurrence using multivariate analysis (P = 0.001, logistic regression; P = 0.001, Cox proportional hazards model). Considering the possible recurrence of vocal fold leukoplakia, long-term follow-up is required after CO₂ laser resection. In conclusion, the size of lesion combined with the pathological grade are important risk factors that predict vocal fold leukoplakia recurrence.

http://ift.tt/2s3DmMW

Association of Modified Frailty Index Score With Perioperative Risk for Patients Undergoing Total Laryngectomy.

Association of Modified Frailty Index Score With Perioperative Risk for Patients Undergoing Total Laryngectomy.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 08;:

Authors: Wachal B, Johnson M, Burchell A, Sayles H, Rieke K, Lindau R, Lydiatt W, Panwar A

Abstract
Importance: Objective preoperative risk assessment tools, such as the Modified Frailty Index (mFI), may inform patient and physician decision making when considering total laryngectomy. Estimation of outcomes may help to set realistic expectations about recovery and outcomes and facilitate optimal resource management.
Objective: To evaluate the association between the mFI score as a measure of frailty and outcomes following total laryngectomy.
Design, Setting, and Participants: Retrospective evaluation using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a risk- and case-mix-adjusted national quality assessment program. The ACS NSQIP database identified 595 patients who underwent total laryngectomy between 2006 and 2012. Patients were assessed for demographics and comorbidity and were stratified on the basis of calculated mFI score. Outcomes, including postoperative complications, length of hospitalization, and discharge destination, were evaluated as a function of increasing frailty using multivariable logistic regression and Cox proportional hazards regression models.
Main Outcomes and Measures: Risk of postoperative complications, length of hospitalization, and discharge disposition.
Results: After exclusion of patients who experienced significant deviation from standard care protocols and those with missing or incomplete data, 343 individuals were included in the analysis. Of these, 278 (81.0%) were men, and the mean age was 63 years (95% CI, 61.9-64.4 years). Increasing frailty resulted in a nonlinear but progressive rise in incidence of postoperative adverse events. Overall, 96 (28.0%) patients experienced a postoperative complication, and patients with an mFI score of 3 or higher were more likely to develop postoperative complications than were patients with an mFI score of 0 (50.0% vs 16.7%; OR, 3.83; 95% CI, 1.72- 8.51). Patients in the highest frailty group experienced a longer mean duration of hospitalization (14.2 vs 9.5 days; difference, 4.7; 95% CI, 1.3-8.1 days) and were more likely to require skilled care after discharge (33.3% vs 3.2%; difference, 30.1%; 95% CI, 7.4%-52.9%).
Conclusions and Relevance: An mFI score of 3 or higher is associated with increased risk for postoperative complications, longer hospitalization, and need for postdischarge skilled care following total laryngectomy. The mFI provides a personalized risk assessment to better inform patients, physicians, and payers when planning a total laryngectomy.

PMID: 28594992 [PubMed - as supplied by publisher]

http://ift.tt/2t1xzEY

Αρχειοθήκη ιστολογίου

Παρασκευή 9 Ιουνίου 2017

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